原位二次动静脉内瘘吻合术后穿刺效果的回顾性分析

Retrospective analysis of puncture effect after situ secondary arteriovenous fistula anastomosis surgery

目的 比较原位二次动静脉内瘘（AVF）吻合术后不同时间穿刺的临床效果.方法 选择近年来本院收治的AVF失功能后行原位二次AVF吻合术的血透患者50例,随机分为对照组（n=25,术后即行深静脉临时置管维持正常透析,1个月后再进行内瘘穿刺）和观察组（n=25,术后首次透析即行内瘘穿刺）,比较两组患者术后l、3、6、12个月时的AVF血流量及术后12个月穿刺并发症的发生率.结果 两组患者在术后1、3、6、12个月时的AVF血流量均达到230mL/min以上,差异无统计学意义（P＞0.05）;对照组和观察组出现穿刺并发症的总发生率分别为58.3％、17.4％,其中两组假性动脉瘤和内瘘狭窄的发生率分别为20.8％、25％和4.3％、8.6％,差异具有统计学意义（P＜0.05）;而两组内瘘闭塞、皮下血肿、内瘘感染的发生率分别为4.2％、4.2％、4.2％和4.3％、4.3％、0％,差异无统计学意义（P＞0.05）.结论 原位二次AVF吻合术后首次透析即进行内瘘穿刺不仅能确保充足的血流量,如穿刺方法适宜,还可能会减少术后并发症.

Objectives To compare clinical effect of Puncture at different time after situ secondary arteriovenous fistula anastomosis surgery.Methods To select.50 hemodialysis patients made situ secondary AVF anastomosis surgery after AVF Loss of function in our ward in recent years.Randomly divided into control group（n =25,made deep venous catheter line temporarily to maintain nomal dialysis after surgery,Then made fistula puncture after a month） and observation group（n =25,made fistula puncture performed immediately at first hemodialysis after surgery）.AVF blood flow was compared between two groups at 1、3、6、12 month after surgery as well as the incidence of biopsy-related complications at 12 month after surgery.Results The AVF blood flow in both groups could reach more than 230ml/min at 1、3、6、12 month after surgery,The difference was not statistically significant （P 〉 0.05） ;The overall incidence of biopsy-related complications of control group and observation group was 58.3% and 17.4% respectively,and the incidence of Pseudoaneurysm and fistula stenosis was 20.8%,25% and 4.3%,8.6% respectively,the difference was statistically significant（P 〈 0.05） ;The incidence of fistula occlusion,subcutaneous hematoma,fistula infection was 4.2% 、4.2% 、4.2% and 4.3% 、4.3% 、0% respectively,the difference was not statistically significant（P 〉0.05）.Conclusions Fistula puncture performed immediately at first hemodialysis after situ secondary AVF anastomosis surgery not only ensured adequate blood flow,but also reduced postoperative complications if puncture using appropriate methods.