新型即穿式人工血管在透析通路中的临床应用研究

Clinical application of a new artificial graft suitable for early cannulation and hemodialysis access

目的比较新型即穿式(ACUSEAL^(TM))及标准人工血管动静脉内瘘在血液透析患者中的应用效果。方法前瞻性观察2016年10月~2017年3月间在中南大学湘雅三医院进行人工血管动静脉内瘘的患者,对其分组,A组应用ACUSEAL^(TM),B组应用标准人工血管。观察12个月,收集患者的基本信息及移植物的相关事件,如:首次穿刺时间、穿刺后按压止血时间、血清肿、移植物感染、血栓形成、窃血综合征、假性动脉瘤,并计算移植物的一期和二期通畅率。结果共75例患者,32例患者使用ACUSEAL^(TM),其余则使用标准人工血管。2组患者的一般资料无统计学差异。A、B 2组首次穿刺时间分别为(4.65±3.64)d、(25.71±4.84)d。A组患者穿刺后按压止血的时间明显缩短,约(13.49±2.08)min,而B组约(19.59±2.84)min。12个月时,新型即穿式比较标准人工血管的一期通畅率、二期通畅率均有统计学差异(t值分别为4.384,4.254;P值分别为0.036,0.039);A组与B组1年累积感染率比较显著减少(t=4.676,P=0.031)。新型即穿式人工血管组包括感染在内的其他并发症均较少。结论新型即穿式人工血管(ACUSEAL^TM)可进行早期穿刺并缩短穿刺后按压止血的时间,通畅率高、并发症少,值得在需要行人工血管、避免中心静脉置管的血液透析患者中优先推广。

Purpose To compare the effect of the new Acuseal arteriovenous graft(AVG)and conventional polytetrafluoroethylene(PTFE)AVG for arteriovenous fistulas in hemodialysis patients.Methods We prospectively observed patients undergoing AVG for arteriovenous fistula operation at the Third Xiangya Hospital of Central South University from October 2016 to March 2017.Patients were divided into two groups according to the graft used for arteriovenous fistula:group A,using Acuseal AVG(Gore,Acuseal),a new type of artificial graft suitable for early annulation and blood access,group B,using PTFE AVG(Gore,Intering).They were observed for 12 months.Patients’basic information,first cannulation time,pressed time on puncture site,seroma,graft infection,thrombosis,stealing syndrome,pseudoaneurysm,and primary and secondary patency rates were collected.Results This study consisted of 75 patients,including 32 cases in group A and 43 cases in group B.There were no differences in basic clinical data between the two groups.The first cannulation time after surgery was 4.65±3.64 days in group A and was 25.71±4.84 days in group B.The pressed time on puncture site was shorter in group A(13.49±2.08 minutes)than in group B(19.59±2.84 minutes).After the surgery for 12 months,the primary patency rate and secondary patency rate of the new artificial grafts early cannulated were statistically different from standard polytetrafluoroethylene(PTFE)graft(t=4.384,t=4.254;P=0.036,P=0.039,respectively),and the one-yearcumulative infection rate in group A was significantly lower than that in group B(t=4.676,P=0.031),indicating that infections and other complications were fewer in group A than in group B.Conclusions The new type of artificial AVG(Acuseal)has the advantages of early cannulation,shorter pressed time on puncture site,higher patency rate and fewer complications.This AVG can be widely used to build up arteriovenous fistula in hemodialysis patients to reduce the use of central venous catheterization.