血管造瘘术后首次透析内瘘血流量与血管通路预后关系研究

Impact of initial blood flow on outcomes of vascular access in hemodialysis patients

目的探讨血液透析患者中首次套管插入术后的血管通路内瘘流量（Qa）与血液通路使用寿命的关系。方法本研究是2005年1月-2013年12月进行的前瞻性随访观察研究。共60例病患者（36位男性）纳入本次研究,入选本研究的患者在2005年1月-2005年12月进行了首次通路手术,且持续进行随访。结果其中9例患者（15%）通路手术失败。手术后首次使用血管通路的平均使用时间为（1.8±1.2）个月,患者平均随访时间为（50.5±25.9）个月。共有25例患者病死亡,6例患者进行了肾移植手术。患者起始Qa值为（757.5±476.4）mL/min。初次插管时间与起始Qa无显著性关系。总共22患者（36.7%）起始Qa〈500 mL/min。糖尿病和人造血管是累积通畅率差的危险因素。结论起始Qa〈500 mL/min是血管初级通常率差的危险因素。

【Objective】To evaluate access flow（Qa） at the time of first cannulation and its relationship to the survival of vascular access in hemodialysis patients. 【Methods】We conducted a prospective observational study from January 2005 to December 2013. We enrolled 60 patients（36 men） who underwent the first access operation between January 2005 and December 2005 and were followed-up for surveillance. 【Results】Maturation failure occurred in nine patients（15%）. Mean time to first use was 1.8±1.2 months after surgery. The patients were followed-up for a mean of 50.5±25.9 months. There were 25 deaths and six kidney transplants in patients with a functioning access.The initial Qa was 757.5±476.4 mL/min. A total of 22 of the 60 patients（36.7%） had an initial Qa〈500 mL/min. Diabetic status and use of a graft were risk factors for low cumulative patency.【Conclusions】InitialQa〈500 mL/min is a risk factor for poor primary patency.