聚四氟乙烯人造血管(PTFE)内瘘在血液透析中的应用

Usage of polytetrafluoroethylene(PTFE) graft fistulas as the blood access in hemodialysis

目的 评价聚四氟乙烯人造血管 (PTFE)内瘘在血液透析中的适应证、使用时间及并发症。方法 32例前臂行PTFE内瘘者共使用 35根PTFE管 ,分析患者年龄、性别、原发病、术前血白蛋白、血红蛋白、血肌酐及手术原因、术后抗凝剂用量、保留时间、合并症及透析充分性。结果 32例慢性透析患者共行 35例次PTFE内瘘 ,平均年龄 5 8.7± 12 .8岁。其中糖尿病肾病 12例 (37.5 % )。术后不通 3例次。 1年内肾移植 5例 ,死亡 2例 ,余 2 5例满 1年时通畅 2 1例次 ,发生栓塞 8例次 ,瘘管感染 4例次 ,瘘管裸露 3例次 ,血清肿 2例次。 1年平均透析 118.2± 12 .6次 ,透析血流量 2 5 0～ 35 0ml/min ,透析充分性指标KT/V为 1.1～ 1.3,再循环率为 3.0 %～ 3.2 %。合并症主要为栓塞、感染、瘘管裸露和血清肿。结论 PTFE内瘘作为一种永久性血透通路 ,尤其适合血管条件差的糖尿病患者 ;PTFE内瘘血流量大 ,透析充分 ,再循环率低 ;其并发症主要为栓塞、感染、瘘管裸露和血清肿 ,栓塞发生率较高 ,应积极抗凝、预防感染。

Objective To evaluate PTFE graft fistulas as the blood access using in hemodialysis (HD) patierns.Methods 32 patients undertook 35 PTFE grafts fistulas in upper arms as the blood access to perform HD.The primary renal disease,patients age,sex,albumin,hemoglobin,platelet,serum creatine and serum lipid before operation were analyzed.The scope of grafts application,reserving time limit,complications and adequacy of HD were observed.Results 32 patients requiring chronic HD received 35 PTFE grafts.Their average ages were 58.7±12.8 (36～82) years old.Diabetic nephropathy were present in 12/32(37.5%).Excluding 3 unsuccessful grafts,5 receiving kidney transplantation and 2 dead patients,21 out of 35 grafts remained unobstructive.Embolisms present in 8.Infections present in 4.Naked grafts present in 3.Serum swelling present in 2.The average HD rate are 118.2±12.6 times per year.Blood flux is 250～350ml/min.KT/V is 1.1～1.3.Recirculation rate is 3.0%～3.2%.The complications were embolisms,infections and naked PTFE grafts.Conclusions PTFE graft fistulas as the permanent blood access to chronic HD patients is appropriate to those natise vessels are too bad to perform automatic fistulas.It has the good quality of better blood flux,lower recirculation and better adequacy for HD.The main complications are embolisms,infections naked PTFE grafts and serum swelling.More attention showld be paid to anticoagulation and antibiotics.