高龄血液透析患者首次自体动静脉内瘘成形术后内瘘的开放率分析研究

Clinical observation on the patency rate of primary autologous arteriovenous fistula in elderly hemodi-alysis patients

目的本研究主要分析老年尤其是70岁以上的高龄血液透析患者首次行自体动静脉内瘘(arteriovenous fistula,AVF)术后内瘘的开放率情况。方法依据手术时患者的年龄,将其分为两2组:高龄组:年龄≥70岁,61例;青壮年组:18岁≤年龄≤55岁,64例。随访18月,记录患者的基本临床资料、手术方式、术后AVF的初级、次级开放率等指标。结果青壮年组的自体AVF中58例为前臂AVF,6例为上臂AVF(9.3%),高龄组的自体AVF中44例为前臂AVF,17例为上臂AVF(27.9%)。高龄组26例患者合并糖尿病(42.6%),较青壮年组明显升高(14.1%)。(P<0.001)两组自体AVF术后的初级、次级开放率无统计学差异。单因素和多因素分析显示,糖尿病是影响术后AVF初级、次级开放率的主要因素。结论高龄组患者首次自体AVF术后内瘘开放率较青壮年组无显著差别,糖尿病是影响自体AVF术后内瘘开放率的主要因素。

Objective To analyze the patency rate of the primary autologous arteriovenous fistula （AVF） in elderly hemodialysis （HD） patients, especially in those of more than 70 years old. Methods HD patients were divided into two groups： the elderly group （≥ 70 years old, n= 61 ,） and the younger group （〉 18 years old and 〈55 years old, n=64）. They were followed up for 18 months, and their clinical data, surgical modality, primary and secondary patency rates were recorded. Results In the younger group, autologous AVF was established in wrist in 58 cases, and in elbow in 6 cases （9.3%）. In the elderly group, autologous AVF was established in wrist in 44 cases, and in elbow in 17 cases （27.9%）. The prevalence of diabetes mellitus was 42. 6% （26/64 ） in the elderly group, significantly higher than that in the younger group （14.1%, P 〈 0.001 ）. No significant differences in primary and secondary patency rates were found between the two groups. Univariate and multivariate analyses showed that diabetes mellitus was the principal factor for the primary and secondary patency rates of autologous AVE Conclusion No significant difference in patency rate of autologous AVF was found between the younger group and the elderly group. Diabetes mellitus was the main factor affecting the patency rate of AVE