日间手术模式开展超声下血液透析血管通路介入治疗效果评价

Evaluation on vascular access-interventional therapy of hemodialysis under ultrasound in day surgery mode

目的探讨日间手术模式开展超声下血液透析血管通路介入治疗的临床效果。方法回顾性分析2018年9月1日至2020年10月31日因血液透析血管通路功能障碍在西安交通大学第一附属医院行超声下介入治疗的患者资料。通过电子病历系统及电话随访收集患者的人口学和临床资料,血管通路的通畅率用Kaplan⁃Meier法进行估算。结果269例患者共行421例次超声下血管通路介入治疗,狭窄病变、慢性闭塞病变和急性闭塞病变的技术成功率分别为98.8%、90.6%和86.4%,其中246例患者406例次(96.4%)获得临床成功。术后肱动脉血流量为821(627,1029)ml/min,较术前[309(202,453)ml/min]明显升高(Z=-13.547,P<0.001)。术中、术后无严重并发症发生。术后6、12、18、24个月血管通路的初级通畅率分别为74%、59%、48%、45%,辅助初级通畅率为94%、91%、88%、82%,次级通畅率为96%、93%、91%、86%。与常规住院手术模式相比,日间手术模式总花费明显降低[12067(10051,13198)元比14986(12411,20643)元,Z=-13.185,P<0.001],住院时间显著缩短[5.1(3.5,6.9)h比73.4(31.6,146.6)h,Z=-13.348,P<0.001]。结论日间手术模式开展超声下血管通路介入治疗不仅安全、有效,而且能够节省费用、缩短住院时间,可以在具备条件的医院尝试开展。

Objective To investigate the clinical effect on ultrasound-guided vascular access-interventional therapy of hemodialysis in day surgery mode.Methods Hemodialysis patients with vascular access dysfunction who underwent ultrasound-guided interventional therapy in the First Affiliated Hospital of Xi'an Jiaotong University from September 1,2018 to October 31,2020 were retrospectively analyzed.Demographic and clinical data were collected by electronic medical record system and telephone follow-up.Kaplan-Meier method was used to analyze the patency rate of vascular access.Results A total of 421 cases of ultrasound-guided vascular access intervention were performed in 269 patients.The technical success rates of stenosis,chronic occlusion and acute occlusion lesion were 98.8%,90.6%and 86.4%,respectively,and 406 cases(96.4%)of 246 patients were clinically successful.The postoperative brachial artery blood flow was 821(627,1029)ml/min,which was significantly higher than 309(202,453)ml/min before the operation(Z=-13.547,P<0.001).No serious complications occurred during and after the operation.At 6,12,18 and 24 months after operation,the primary patency rate was 74%,59%,48%and 45%,respectively,the assisted primary patency rate was 94%,91%,88%and 82%,and the secondary patency rate was 96%,93%,91%and 86%.Compared with the conventional inpatient surgery mode,the total cost of the day surgery mode was significantly reduced[12067(10051,13198)yuan vs 14986(12411,20643)yuan,Z=-13.185,P<0.001],and the hospital stay was significantly shortened[5.1(3.5,6.9)h vs 73.4(31.6,146.6)h,Z=-13.348,P<0.001].Conclusion It is safe and effective to perform interventional therapy for vascular access malfunction under ultrasound in day surgery mode,which can save cost and time of hospitalization,and can be carried out in hospitals with relevant conditions.