人工血管内瘘自体静脉近静脉吻合口狭窄术前影响因素分析

Analysis of preoperative factors for vein anastomotic stenosis of arteriovenous graft fistula

目的观察终末期肾病患者人工血管动静脉内瘘通畅情况,探究人工血管自体静脉近静脉吻合口狭窄的术前影响因素。方法选择2016年在北京市海淀医院肾内科建立人工血管动静脉内瘘的138例患者,收集临床资料并进行术后内瘘复查和随访,统计术后初级通畅率、初级辅助通畅率、次级通畅率,对人工血管内瘘自体静脉近静脉吻合口狭窄组和非狭窄组的术前资料进行分析,以确定狭窄发生的术前影响因素。结果人工血管动静脉内瘘术后6、12个月初级通畅率分别为81.1%、52.1%,初级辅助通畅率为88.1%、64.2%,次级通畅率为95.7%、91.0%;Cox多因素回归分析显示,吸烟(HR:2.713, 95%CI:1.324～5.56,P=0.006)是人工血管内瘘自体静脉近静脉吻合口狭窄术前独立危险因素,而使用抗血小板药物(HR:0.242,95%CI:0.102～0.572,P=0.001)是其独立保护性因素。结论人工血管动静脉内瘘手术患者经过积极处理可获得较好的次级通畅率。吸烟是人工血管内瘘自体静脉近静脉吻合口狭窄的危险因素,而抗血小板药物的使用是内瘘通畅的保护性因素。

Objective To investigate the patency and the preoperative factors for vein anastomotic stenosis of arteriovenous graft(AVG)fistulas in end-stage renal disease patients.Method A total of 138 cases treated with AVG fistula operation at the Renal Department of Haidian Hospital in 2016 were enrolled in this study.Their clinical data were collected.They were followed up after the operation to investigate their primary patency rate,assisted primary patency rate and secondary patency rate.The preoperative factors for vein anastomotic stenosis were identified through the analyses of preoperative clinical data of the patients with vein anastomotic stenosis and those without vein anastomotic stenosis.Result After the operation for 6 months,the primary patency,assisted primary patency and secondary patency rates were 81.1%,88.1%and 95.7%,respectively.After the operation for one year,the primary patency,assisted primary patency and secondary patency rates were 52.1%,64.2%and 91.0%,respectively.Cox multivariate regression analysis showed that smoking(HR:2.713,95%CI:1.324~5.56,P=0.006)was an independent risk factor and antiplatelet therapy(HR:0.242,95%CI:0.102~0.572,P=0.001))was an independent protective factor for vein anastomotic stenosis of AVG fistulas.Conclusion The secondary patency rate of AVG fistulas was acceptable after interventions.Smoking was a risk factor and antiplatelet therapy was a protective factor for vein anastomotic stenosis of AVG fistulas.