前臂动静脉内瘘血栓形成的原因及预防

Cause and prevention of early thrombus in A-V internal fistulas,summarize the preventive measure

目的探讨动静脉内瘘术后早期血栓形成的原因,总结有效的预防措施。方法分析289例行前臂动静脉内瘘术患者的资料,观察内瘘使用及早期血栓形成情况与慢性肾功能衰竭原发病的关系。结果总结出10个主要的危险因素:糖尿病肾病、高血压肾病、肾性高血压、血压≤110/70 mm Hg、接受促红细胞生成素治疗、血红蛋白≥130 g/L、高凝或高黏状态、动脉射血低、静脉回流不良或静脉压高、动脉硬化或动脉壁分层、补漏缝合等。结论血液透析患者动静脉内瘘早期血栓形成的基础原因中以糖尿病及其血管病变最为重要,其次是血管外科操作技术问题。术前纠正高凝状态等危险因素,术中提高操作技能,术后给予适当的抗凝治疗可以提高内瘘通畅率。

Objective To study the cause of early thrombus in A-V internal fistulas,summarize the preventive measure.Methods The used condition of A-V internal fistulas and the connection of CRF were observed by analysing the data of falure of A-V internal fistula patiants.Results Ten dangerous factors were summed up,including diabetic nephropathy,hypertensive renal disease,BP≤110/70 mm Hg,therapy of EPO,HB≥130 g,high condenser blood,inferior vein-reflux,arteriosclerosis,compensatory suture and so on.Conclution The main cause of early thrombs in A-V fistulas is diabetic nephropathy and blood tubing disease of diabetic nephropathy.secondary cause is technical matters of vascular surgery.So rectifing the high condenser blood before operations,raising the skill of vascular anatomosis,appropriate conticoagulation after operation,that patency rates of A-V internal fistulas were enhanced.