扣眼穿刺法与绳梯穿刺法对动静脉内瘘功能影响的Meta分析

The effects of buttonhole versus rope-ladder cannulation on the function of arteriovenous fistulas:a meta-analysis

目的分析扣眼穿刺法与绳梯穿刺法对维持性血液透析(maintenance hemodialysis,MHD)患者自体动静脉内瘘(arteriovenous fistula,AVF)的影响,选取适合AVF患者的最佳穿刺方法,更好地保护内瘘。方法通过计算机检索PubMed、Cochrane Library、Elsevier、Wiley、中国知网、中国生物医学文献、维普和万方等国内外数据库中扣眼穿刺法与绳梯穿刺法对MHD患者影响的相关研究,由2位评价者独立进行文献筛选、资料提取、质量评价并进行交叉核对,采用RevMan 5.3软件进行Meta分析。结果最终纳入9个研究,共757例患者。Meta分析结果显示:在MHD患者中,扣眼组的感染发生率随着时间的增加而大幅上升,随访时间≤6个月时,虽然2组间差异无统计学意义(P=0.080),但扣眼组的感染发生率是绳梯组的3.42倍[RR=3.42,95%CI:(0.86~13.69)],随访时间>6个月时,扣眼组的感染发生率增至绳梯组的14.43倍(RR=14.43,95%CI:3.50~59.55),2组间的差异具有统计学意义(RR=8.33,95%CI:3.17~21.88,P=0.000);绳梯组血管狭窄或阻塞发生率低于扣眼组(RR=4.64,95%CI:2.01~10.72,P=0.000);2组患者血肿(RR=0.70,95%CI:0.42~1.16,P=0.170)和血栓(RR=0.83,95%CI:0.43~1.58,P=0.570)发生率的差异无统计学意义。结论在常规AVF患者穿刺时,绳梯法比扣眼法有助于降低远期并发症,更利于保护内瘘血管功能以延长AVF使用寿命。我们需要更多研究来帮助制定改进扣眼穿刺技术的策略,而不是禁用此技术。作为绳梯穿刺法的有益补充,应使扣眼穿刺法发挥其优势作用,更好地服务于AVF患者。

Objective To analyze the effects of buttonhole cannulation and rope-ladder cannulation on the function of autologous arteriovenous fistula(AVF)in maintenance hemodialysis(MHD)patients,and to select the best puncture method suitable for better use and protection of the AVF.Methods We searched for the literature relating to the influence of buttonhole cannulation and rope-ladder cannulation on MHD patients through PubMed,Cochrane Library,Elsevier,Wiley,CNKI,CBM,VIP,Wan Fang,and other Chinese and foreign databases by computer.Two evaluators independently screened the literature according to the inclusion and exclusion criteria.Methodological quality evaluation was conducted for the selected articles.Meta-analysis was carried out using RevMan5.3 software.Results Nine articles including 757 patients were finally selected.Meta-analysis showed that the incidence of infection in the buttonhole cannulation group increased significantly with the increase of time.When the follow-up period lasted≤6 months,the infection rate in the buttonhole group was 3.42 times higher than that in the rope-ladder group(RR=3.42;95%CI 0.86,13.69)but without statistical significance(P=0.080).When the follow-up period lasted>6 months,the infection rate in the buttonhole group increased to 14.43 times higher than that in the rope-ladder group(RR=14.43;95%CI3.50,59.55),and the difference between the two groups was statistically significant(RR=8.33;95%CI 3.17,21.88;P=0.000).The incidence of vascular stenosis or obstruction was lower in the rope-ladder group than in the buttonhole group(RR=4.64;95%CI 2.01,10.72;P=0.000).There were no statistical differences in the incidence of hematoma(RR=0.70;95%CI 0.42,1.16;P=0.170)and thrombosis(RR=0.83;95%CI 0.43,1.58;P=0.570)between the two groups.Conclusion In the puncture for patients with AVF,rope-ladder cannulation method was better than buttonhole cannulation method to reduce long-term complications,and is beneficial to protect AVF and extend service life of the AVF.However,more researches are required to help develop strategies to improve buttonhole cannulation technique rather than to disable it.To better serve the patients with AVF,the advantages of buttonhole cannulation should be used as a supplement of rope-ladder cannulation.