维持性血液透析患者内瘘情况分析

Clinical analysis on application of arterioveneous fistula in maintenance hemodialysis patients

目的分析血液透析患者的内瘘使用情况以及内瘘失功常见原因及其处理。方法采集436例患者病史和体格检查,动静脉内瘘手术方法分别为非惯用手前臂桡动脉和头静脉侧侧吻合,结扎远心端头静脉,形成改良端侧吻合,少数为惯用手前臂桡动脉和头静脉侧侧吻合,观察内瘘一般情况,统计患者开始透析时间,内瘘手术时间,开始使用时间,内瘘失功时间,目前内瘘使用情况。结果436例患者完成统计,其中男性245例,女性191例,内瘘失功76例,138例患者肾移植术后自然堵塞。结论自体内瘘是维持性血液透析患者的主要血管通路,内瘘失功的主要原因是内瘘血栓形成和内瘘狭窄,糖尿病、低血压、高超滤量是易患因素,正确的穿刺和透析结束后绑带绑扎时间和方法亦很重要。

Objective To investigate the application of arterioveneous fistula in hemodialysis patients and to find out the cause and management of fistula dysfunction. Methods We collected disease history and physical examinations from 436 patients. Arterioveneous fistula was built by side-to-side anastomosis between radial artery and cephalic vein and ligation of cephalic vein at the distal part to form an improved terminal-side anastomosis in the unaccustomed-used forearm. In a few patients fistula was set in the accustomed-used forearm. We recorded general condition of the fistula, onset of hemodialysis, time of the fistula surgery, use of the fistula and period of fistula dysfunction. Results In the 436 patients we observed, 245 patients were male, 191 patients were female. Fistula failure was found in 76 cases. Fistula occlusion occurred naturally after kidney transplantation in 138 patients. Conclusion Autologous fistula is the main route for maintenance hemodialysis. Thrombus formation and stenosis cause fistula failure. Diabetes, hypotension and high volume ultrafiltration facilitate the fistula failure. Correct puncture manipulation and appropriate pressure by banding after dialysis prevent the fistula failure.