不同透析血流量对血液透析患者内瘘并发症的影响

Effect of different dialysis blood flow on internal fistula complications in hemodialysis patients

目的探讨不同透析血流量对血液透析患者内瘘并发症的影响。方法选择2019年1月至2019年3月在温州医科大学附属第二医院首次进行自体动静脉内瘘(autologous arteriovenous fistula,AVF)手术的患者40例和采用AVF进行常规血液透析的患者40例。新AVF患者随机分为观察组和对照组(n=20),观察组初始透析血流量160~200 ml/min,1个月后220~250 ml/min;对照组初始透析血流量220~250 ml/min,1个月后280~310 ml/min。成熟AVF患者随机分为观察组和对照组(n=20),观察组透析血流量220~250 ml/min;对照组透析血流量280~310 ml/min。患者每周透析3次,持续透析12个月。观察各组内瘘失功率和并发症发生情况,检测相关生化指标,并对透析充分性进行评估。结果观察组内瘘失功率和并发症发生率均明显减少,其中新AVF观察组并发症发生率与对照组比较差异具有统计学意义(χ^2=6.465,P=0.011);成熟AVF患者观察组内瘘失功率(χ^2=3.135,P=0.077)和并发症发生率(χ^2=3.135,P=0.077)与对照组相比均无显著差异。新AVF和成熟AVF患者观察组的透析充分率分别较对照组下降,但Fisher精确检验分析无显著差异(P分别为0.451,0.407)。结论降低血流量能显著减少AVF患者内瘘并发症的发生,改善AVF患者内瘘预后,且对患者的透析充分性无显著影响。

Objective To explore the effect of different dialysis blood flow on complications of internal fistula in hemodialysis patients.Methods Forty patients undergoing autologous arteriovenous fistula(AVF)surgery for the first time and 40 patients using AVF for routine hemodialysis in The Second Affiliated Hospital of Wenzhou Medical University from January to March 2019 were enrolled in this study.Patients with new AVFs were randomly divided into model group(n=20)and control group(n=20).In model group,the dialysis blood flow was 160~200 ml/min at the beginning and increased to 220-250 ml/min after one month.In control group,the dialysis blood flow was initially 220~250 ml/min and increased to 280~310 ml/min after one month.Patients with mature AVFs were also randomly divided into model group(n=20)and control group(n=20).The dialysis blood flow was 220~250 ml/min in model group and was 280~310 ml/min in control group.All patients were dialyzed 3 times a week for 12 months.Dysfunction and complications of the AVFs were observed,related biochemical indicators were assayed,and dialysis sufficiency was evaluated in these groups.Results Dysfunction and complications of the AVFs were significantly reduced in the two model groups.In patients with new AVFs,the rate of AVF complications was significantly lower in model group than in control group(χ^2=6.465,P=0.011).In patients with mature AVFs,the rates of AVF dysfunction(χ^2=3.135,P=0.077)and AVF complications(χ^2=3.135,P=0.077)had no differences between model group and control group.In patients with new AVFs and with mature AVFs,dialysis sufficiency was lower in model groups than in their respective control groups,but without statistical significance(Fisher exact analyses,P=0.451 and 0.407).Conclusion Reduction of dialysis blood flow can decrease the presence of AVF complications and improve the prognosis of AVF,without significant impact on dialysis sufficiency.