改良肘部高位动静脉内瘘术对心功能不全尿毒症患者手术成功率及并发症的影响

Effect of Modified Elbow High Arteriovenous Fistula on Success Rate and Complications in Patients with Cardiac Insufficiency

目的:对改良肘部高位动静脉内瘘术在心功能不全尿毒症患者中的成功率及并发症进行研究与探讨,为临床研究提供参考。方法:选取我院2014年1月至2016年12月治疗的40例心功能不全尿毒症患者予以研究,应用简单随机法分为观察组与对照组,每组各20例。对照组应用传统高位动静脉内瘘术治疗;观察组采用改良肘部高位动静脉内瘘术进行治疗;对比两组研究对象治疗后的效果。结果:观察组的成功率为100%,明显的高于对照组的85.0%,且差异有统计学意义(P<0.05);术后出血量明显的优于对照组(P<0.05);对照组的手术时间明显的高于观察组,且差异具有统计学意义(P <0.05)。观察组术后并未出现严重的并发症,只有1例出现通路感染;而对照组心力衰竭、通路感染及血管壁附壁血栓的发生率分别为20.0%、25.0%及15.0%,观察组并发症发生率明显的低于对照组(P<0.05)。观察组术后通畅率优于对照组,但无统计学差异(P>0.05);经过24个月的随访后,对两组长期通畅率进行评价显示,观察组的长期通畅率明显的高于对照组,差异显著(P<0.05)。结论:在心功能不全尿毒症患者中应用改良肘部高位动静脉内瘘术,因其有着较高的手术成功率及长期使用通畅率,较少的术后并发症,对心脏功能没有造成影响等诸多优点,是一种理想的自体内瘘手术方案,值得临床推广应用。

Objective: To study and discuss the success rate and complications of modified elbow high arteriovenous fistula in patients with cardiac insufficiency uremia, and to provide reference for clinical study. Methods: 40 uremic patients with cardiac insufficiency treated from January 2014 to December 2016 were selected for the study. They were divided into observation group and control group by simple random method, 20 cases in each group. The control group was treated with traditional high arteriovenous fistula;the observation group was treated with modified high elbow arteriovenous fistula. The effect of the two groups after treatment was compared. Results: The success rate of the observation group was 100.0%, obviously higher than that of the control group (85.0%), and the difference was significant (p<0.05). The postoperative bleeding volume was obviously better than that of the control group (p<0.05);the operation time of the control group was significantly higher than that of the observation group, and the difference was statistically significant (p<0.05). The incidence of heart failure in the control group was 20.0%, 25.0% and 15.0%, respectively, and the incidence of complications in the observation group was significantly lower than that of the control group (p<0.05). The rate of postoperative bowel movement in the observation group was superior (P>0.05). After 24 months follow-up, the long-term defecation rate of the two groups was significantly higher than that of the control group (P<0.05). Discussion: The application of modified high elbow arteriovenous fistula in patients with new dysfunction uremia has many advantages, such as high success rate, long-term use patency rate, fewer complications, no impact on cardiac function and so on. It is an ideal autologous internal fistula operation scheme, which is worthy of clinical application.