高位人工动静脉内瘘在维持性血液透析患者中的应用效果及对心功能的影响  

Application effect of high artificial arteriovenous fistula in maintenance hemodialysis patients and its impact on cardiac function

作　　者：董加宝 谢莹莹 帅建炜 田德名 Dong Jiabao;Xie Yingying;Shuai Jianwei;Tian Deming(Department of Nephrology,Maanshan 17th Metallurgical Hospital,Maanshan 243000,Anhui,China;Department of Intervention,Maanshan 17th Metallurgical Hospital,Maanshan 243000,Anhui,China)

机构地区：[1]马鞍山十七冶医院肾内科,安徽马鞍山243000 [2]马鞍山十七冶医院介入科,安徽马鞍山243000

出　　处：《血管与腔内血管外科杂志》2024年第8期1006-1010,共5页Journal of Vascular and Endovascular Surgery

摘　　要：目的探讨高位人工动静脉内瘘在维持性血液透析(MHD)患者中的应用效果及对患者心功能的影响。方法收集2017年1月至2021年6月于马鞍山十七冶医院治疗的100例MHD患者的临床资料,根据手术方法的不同将患者分为观察组(n=55,采用改良高位人工动静脉内瘘进行治疗)和对照组(n=45,采用常规头静脉与桡动脉吻合动静脉内瘘进行治疗)。比较两组患者的手术相关指标,手术前后心功能指标[心输出量(CO)、心脏指数(CI)、射血分数(LVEF)]、手术前后血流动力学指标[收缩压(SBP)、舒张压(DBP)、心率(HR)]及术后内瘘相关并发症发生情况。结果观察组患者的手术时间短于对照组患者,术中出血量少于对照组患者,差异均有统计学意义(P﹤0.05)。两组患者的手术成功率比较,差异无统计学意义(P﹥0.05)。术后,两组患者的CO、CI及LVEF水平均高于本组术前,且观察组患者的CO、CI及LVEF水平均高于对照组患者,差异均有统计学意义(P﹤0.05)。术后,两组患者的SBP、DBP均高于本组术前,HR低于本组术前,且观察组患者的SBP、DBP均高于对照组患者,HR低于对照组患者,差异均有统计学意义(P﹤0.05)。观察组患者术后内瘘相关并发症总发生率为10.91%(6/55),低于对照组患者的28.89%(13/45),差异有统计学意义(P=0.023)。结论同常规头静脉与桡动脉吻合动静脉内瘘相比,高位人工动静脉内瘘的效果更佳,可缩短MHD患者的手术时间,减少术中出血量,改善患者的心功能和血流动力学,降低术后内瘘相关并发症的发生率。Objective To investigate the application effect of high artificial arteriovenous fistula in maintenance hemodialysis(MHD)patients and its impact on cardiac function.Method The clinical data of 100 patients with MHD treated at Maanshan 17th Metallurgical Hospital from January 2017 to June 2021 were collected,and the patients were divided into the observation group(n=55,treated with modified high artificial arteriovenous fistula)and the control group(n=45,treated with conventional cephalic vein and radial artery anastomosis arteriovenous fistula)according to different surgical methods.The surgical related indicators,preoperative and postoperative cardiac function indicators[cardiac output(CO),cardiac index(CI),ejection fraction(LVEF)],hemodynamic indicators[systolic blood pressure(SBP),diastolic blood pressure(DBP),heart rate(HR)],and incidence of postoperative fistula related complications between two groups of patients were compared.Result The surgical time of the observation group patients was shorter than that of the control group patients,and the intraoperative blood loss was less than that of the control group patients,and the differences were statistically significant(P<0.05).There was no statistically significant difference in the surgical success rate between the two groups of patients(P>0.05).After surgery,the levels of CO,CI,and LVEF in both groups of patients were higher than before surgery,and the levels of CO,CI,and LVEF in the observation group were higher than those in the control group,and the differences were statistically significant(P<0.05).After surgery,the SBP and DBP of both groups of patients were higher than before surgery,and the HR was lower than before surgery.In addition,the SBP and DBP of the observation group were higher than those of the control group,and the HR was lower than that of the control group,and the differences were statistically significant(P<0.05).The total incidence of postoperative fistula related complications in the observation group was 10.91%(6/55),which was lower

关 键 词：高位人工动静脉内瘘 维持性血液透析 心功能 血流动力学 

分 类 号：R543[医药卫生—心血管疾病]