内瘘穿刺方向对自体动静脉内瘘功能的影响

Impact of fistula puncture directions on function of arteriovenous fistula

目的探讨内瘘穿刺方向对自体动静脉内瘘功能的影响。方法将150例使用自体动静脉内瘘的维持性血液透析患者随机分为三组各50例,分别采用向心穿刺(顺穿)、离心穿刺(反穿)和顺反穿交替的方式进行内瘘穿刺,比较2年后三组透析充分率、内瘘假性动脉瘤及狭窄发生情况。结果最终完成研究143例。三组透析充分性比较,差异无统计学意义(P>0.05);三组内瘘假性动脉瘤和狭窄发生率比较,差异有统计学意义(均P<0.05),反穿组假性动脉瘤发生率最高,顺穿组内瘘狭窄发生率最高。结论顺反穿交替穿刺技术在不影响透析效果的前提下,可有效降低自体动静脉内瘘动脉瘤和狭窄的发生。

Objective To explore impact of fistula puncture directions on function of arteriovenous fistula（AVF）.Methods Totally,150 maintenance hemodialysis patients with AVF were randomized into 3 groups of 50.By using rope-ladder puncture technique along the fistula,the 3 groups received either unidirectional puncture with the needles directed to the heart（group 1）,retrograde puncture with needles running away from the heart（group 2）,or both punctures（group 3） respectively.Incidence rate of dialysis adequacy,fistula pseudoaneurysm and stenosis were compared among 3 groups after 2 years.Results One hundred and forty-three patients finished the study.No significant difference was found in dialysis adequacy among the 3 groups（P〉0.05）.Incidence of fistula pseudoaneurysm or stenosis among the 3 groups had statistical differences（P〈0.05 for both）,with the highest incidence of pseudoaneurysm in group 2 and the highest incidence of stenosis in group 1.Conclusion Fistula puncture by using both unidirectional and retrograde methods can achieve satisfactory dialysis adequacy and reduce incidence of fistula pseudoaneurysm and stenosis.