血液透析患者前臂贵要静脉转位内瘘与标准内瘘应用的比较

Comparison between forearm basilic vein transposition arteriovenous fistula and standard arteriovenous fistula in maintenance hemodialysis patiens

目的：比较前臂贵要静脉转位内瘘与标准内瘘作为血管通路的透析充分性及并发症,探讨前臂贵要静脉转位内瘘在血液透析中的意义. 方法：选择徐州市中心医院肾脏内科2010年10月至2012年9月新建立贵要静脉转位内瘘的患者13例（A组）,新建立标准内瘘的患者73例（B组）,随访13～37月,比较两组患者年龄、透析血流量、观察终点前1月心脏射血分数（EF）、尿素清除指数（Kt/V）、内瘘成熟时间、内瘘使用时间、内瘘静脉可穿刺长度及观察期两组血栓等并发症、死亡发生情况.A组采用微创手术方式将前臂贵要静脉转位与桡动脉端侧吻合. 结果：两组患者在年龄、透析血流量、术前及术后EF、内瘘血管可穿刺长度、Kt/V、通路使用时间、并发症、病死率方面均无统计学差异.A组手术时间、内瘘成熟时间、抗凝比例高于B组,差异有统计学意义.未发生肿胀手综合征、窃血综合征和肢体缺血等并发症,对患者的心功能未造成不良影响. 结论：前臂贵要静脉转位内瘘与标准内瘘均可达到充分透析且并发症少,前臂贵要静脉转位内瘘是无法建立标准内瘘时的一种良好替代.

Objective： To compare dialysis adequacy and complications between hemodialysis patients using autologous arteriovenous fistula with forearm basilic vein transposition vs. those using standard arteriovenous fistula as blood access, and to explore the significance of autologous arteriovenous fistula with forearm basilie vein transposition in patients with maintenance hemodialysis. Methodology：Eighty six patients with maintenance hemodialysis were selected in this retrospective study from October 2010 to September 2012. They were divided into two groups according to the establishing way of arteriovenous fistula： one group was given the newly established autologous arteriovenous fistula with forearm basilie vein transposition （A group, n = 13） and the other group given a newly created standard fistula （B group, n = 73 ） .The age, dialysis blood flow, ejection fraction within one month before the end of observation, Kt/V, fistula maturation time, blood access life-span, the length of fistula vein puncture, complications, and death occurrence were compared between two groups during a follow-up period of 13-37 months. The operation method for A group was forearm basilic vein transposition with tiny incision for arteriovenous fistula. Results：There was no significant difference in age, dialysis blood flow, blood access life-span, the ejection fraction before and after operation, the length of fistula vein puncture, Kt/V, blood access life-span, the mortality rate between two groups （P〉0. 05）. The operation time, fistula maturation time, and anticoagulation rate were higher in the A group than that in the B group, those differences were statistically significant （P〈0. 05 ）. No complications such as the hand swelling syndrome, stolen blood syndrome, and limb ischemia were observed, and also no adverse effects on the patients＇ cardiac function were found. Conclusion： Both of two groups can achieve adequate dialysis, and the complications are less. Autologous arteriovenous fistula with forearm hasilic vein transposition is a good alternative blood access for maintenance hemodialysis patients when the standard arteriovenous fistula is unable to establish.