不同血液透析龄患者自体动静脉内瘘功能状态临床分析

Clinical Analysis of Functional Status of Autologous Arteriovenous Fistula in Patients Undergoing Different Years of Hemodialysis

目的分析不同血液透析龄患者自体动静脉内瘘(AVF)功能状态。方法回顾性分析84例应用AVF行血液透析的临床资料,按照不同透析龄将其分为4组,即透析龄<5年为1组(n=31),透析龄5~10年为2组(n=42),透析龄10~20年为3组(n=9),透析龄≥20年为4组(n=2)。所有患者均随访至2018年6月,观察AVF血流量与并发症发生情况,记录AVF重建情况。结果4组初始瘘口直径、现瘘口直径、现瘘口血流速度、头静脉血栓形成发生率及瘤样扩张发生率比较差异无统计学意义(P>0.05)。1组17例行内瘘重建1次,其中1例行超声引导下球囊扩张(PTA)治疗;6例行2次内瘘重建。2组行内瘘重建1和2次各15例,行内瘘重建3次2例,其中2例分别透析6和8年后改为腹膜透析,1例透析9年后行肾移植。3组3例行内瘘重建1次,1例行内瘘重建2次。4组均行内瘘重建2次,其中1例每年行PTA治疗1或2次。结论维持性血液透析患者AVF失功能等并发症发生率高,定期行AVF彩色多普勒超声检查,可有效监测与诊断患者AVF功能状态,且内瘘重建与PTA是治疗AVF失功能的有效措施。

Objective To analyze the functional status of autologous arteriovenous fistula(AVF)in patients undergoing different years of hemodialysis.Methods The clinical data of 84 patients undergoing hemodialysis using AVF were retrospectively analyzed.According to different years of hemodialysis,the patients were divided into 4 groups,namely,hemodialysis for<5 years as group One(n=31),hemodialysis for 5-10 years as group Two(n=42),hemodialysis for 10-20 years as group Three(n=9),and dialysis for≥20 years as group 4(n=2).All patients were followed up until June 2018.AVF blood flow and complications were observed,and AVF reconstruction was recorded.Results There were no statistically significant differences in initial fistula diameter,current fistula diameter,current fistula blood flow velocity,and incidence of cephalic vein thrombosis and tumor-like dilatation between different groups(P>0.05).Seventeen patients underwent AVF reconstruction once in group One,of which 1 was treated with ultrasound-guided balloon dilatation(PTA).AVF reconstruction was performed on six patients twice.In group Two,15 patients underwent AVF reconstruction once and twice respectively,and 2 patients underwent AVF reconstruction three times.Among them,2 patients underwent peritoneal hemodialysis at 6 years and 8 years after hemodialysis respectively,and 1 patient underwent kidney transplantation at 9 years after dialysis.In group Three,3 patients underwent AVF reconstruction once and 1 patient underwent AVF reconstruction twice.In group Four,all patients underwent AVF reconstruction twice,among which 1 patient received PTA treatment 1-2 times per year.Conclusion The incidence of complications such as loss of AVF function in MHD patients is high.Therefore,regular color doppler ultrasound examination of AVF can effectively monitor and diagnose the functional status of AVF in patients.In addition,AVF reconstruction and PTA are effective measures to treat function loss of AVF.