自体动静脉内瘘和人造血管内瘘在维持性血液透析病人的应用对比及安全性分析

Application comparison and safety analysis of autogenous arteriovenous fistula and arteriovenous graft-fistula in patients with MHD

目的分析自体动静脉内瘘(AVF)和人造血管内瘘(AVG)在维持性血液透析(MHD)病人的应用对比及安全性。方法回顾性选取2014年1月至2016年1月南阳市中心医院收治的MHD病人81例,按治疗方式分为AVF组46例(给予AVF治疗)与AVG组35例(给予AVG治疗),比较两组血管径路首次通畅率、再次通畅率、血管径路中位生存时间以及并发症发生情况。结果AVF组血管径路首次通畅率明显高于AVG组,差异有统计学意义(6个月通畅率80.43%比37.14%,12个月通畅率65.22%比11.43%,24个月通畅率28.26%比5.71%,36个月通畅率19.57%比2.86%,均P<0.05);AVF组血管径路再次通畅率与AVG组比较,差异无统计学意义(P>0.05);AVF组血管径路中位生存时间为39.344个月,AVG组中位生存时间为26.273个月,两组比较差异无统计学意义(P>0.05);AVF组血管狭窄、血栓形成、感染并发症发生率低于AVG组,差异有统计学意义(P<0.05),血管瘤、皮下血肿、血清肿、渗血并发症发生率与AVG组比较,差异无统计学意义(P>0.05)。结论应用AVF治疗MHD,血管径路首次通畅率高于AVG,血管狭窄、血栓形成、感染并发症发生率低于AVG组,安全性较好,但两种手术方式血管径路再次通畅率、中位生存时间无明显差异。

Objective To analyze the application and safety of autologous arteriovenous fistula(AVF)and arteriovenous graft-fistula(AVG)in patients with maintenance hemodialysis(MHD).Methods A retrospective analysis was performed on 81 patients with MHD in Nanyang Central Hospital from January 2014 to January 2016 were selected,and the patients were assigned into AVF group(n=46,AVF treatment)and AVG group(n=35,AVG treatment)according to the treatment methods.The first patency rate and re-patency rate of vascular pathway,median survival time of vascular pathway and occurrence of complications were compared between the two groups.Results The first patency rate of vascular pathway in AVF group was significantly higher than that in AVG group(80.43%vs.37.14%in 6 month,65.22%vs.11.43%in 12 month,28.26%vs.5.71%in 24 month,19.57%vs.2.86%in 36 month,all P<0.05).There was no significant difference in the re-patency rate of vascular pathway in AVF group compared with the AVG group(P>0.05).Median survival time of vascular pathway was 39.344 months in AVF group and was 26.273 months in AVG group,and there was no significant differ‐ence between the two groups(P>0.05).The incidence rates of complications of vascular stenosis,thrombosis and infection complica‐tions in AVF group were lower than those in AVG group,the difference was statistically significant between the two group(P<0.05),and the incidence rates of hemangioma,subcutaneous hematoma,seroma and errhysis were not significantly significant(P>0.05).Con‑clusions In the treatment of MHD with AVF,the first patency rate of vascular pathway is higher than that of AVG,the incidence rates of vascular stenosis,thrombosis and infection is lower than that of AVG,and the safety is better.But there are no significant differences in the re-patency rate and median survival time of vascular pathway between the two surgical methods.