血液透析人工血管动静脉内瘘感染的外科治疗  

Surgical treatment for arteriovenous graft infection in hemodialysis

作　　者：傅麒宁[1] 赵渝[1] FU Qi-ning;ZHAO Yu(Department of Vascular Surgery,the First Affiliated Hospital of Chongqing Medical University,Chongqing 400016,China)

机构地区：[1]重庆医科大学附属第一医院血管外科,重庆400016

出　　处：《中国实用外科杂志》2024年第12期1378-1381,共4页Chinese Journal of Practical Surgery

基　　金：国家重点研发计划项目(No.2023YFC2412400)。

摘　　要：感染是人工血管动静脉内瘘(AVG)最为严重的并发症。及时诊断、及时处理对于防止感染扩散蔓延有重大意义。“降阶梯”式抗生素使用联合负压创面治疗是基础的治疗手段。根据感染范围、病人总体情况、人工血管本身情况决定感染人工血管的切除范围。对于感染范围相对局限者,人工血管部分切除伴同期或二期新人工血管桥接植入尽管有更高的感染复发风险,但对于透析病人长期预后而言更为有利,但术中有更多的细节需要把握以降低感染复发风险。在AVG围手术期和后期使用阶段,规范的无菌操作和细致的管理对于预防感染有重要意义。目前一些新型材料人工血管为降低AVG感染提供了新的思路,有望为透析病人高质量的长期存活带来新的希望。Infection is the most serious complication of arteriovenous graft(AVG).Timely diagnosis and treatment are of great significance to prevent the spread of infection.Antimicrobial de-escalation combined with negative pressure wound therapy is the basic treatment.According to the range of infection,the overall condition of the patient,and AVG itself,the range of graft explantation is determined.For patients with relatively limited infection,partial graft explantation combined with one-stage or two-stage new graft by-pass is more favorable for the long-term prognosis of hemodialysis patients,although with a higher risk of reinfection.However,more details need to be noticed during the operation to reduce the risk of reinfection.In the perioperative and later stages of AVG cannulation,standardized aseptic protocol,and careful management are important for infection prevention.At present,some new graft material provide a new idea for reducing AVG infection,which is expected to bring new hope for high-quality long-term survival of dialysis patients.

关 键 词：人工血管动静脉内瘘 感染 人工血管部分切除术 

分 类 号：R6[医药卫生—外科学]