胸壁与上肢人工血管透析通路的通畅率及影响因素比较

发布时间：2018-06-17 13:06

本文选题：透析通路 + 胸壁人工血管透析通路　；参考：《中国微创外科杂志》2016年04期

【摘要】：目的评估胸壁人工血管透析通路(arteriovenous axillary loop graft,AVALG)的临床疗效,比较与上肢(前臂、上臂)人工血管透析通路在通畅率及其影响因素的区别。方法回顾性分析2008年6月~2015年9月我科实施人工血管动静脉瘘术(arteriovenous graft,AVG)69例(98例次)终末期肾病资料。前臂AVG 44例(64次),上臂AVG 11例(20次),AVALG 14例(14次)。应用生存曲线、log-rank检验、Cox多因素回归分析等比较通畅率及并发症的差异,探讨通畅率的影响因素。结果前臂AVG、上臂AVG、AVALG的6个月和1年初级通畅率分别为59.5%、56.3%、92.8%和43.7%、49.1%、92.8%,次级通畅率分别为82.3%、78.9%、92.8%和72.5%、68.8%、92.8%,AVALG的初级通畅率及次级通畅率均显著高于前臂、上臂AVG(P0.05)。Cox多因素分析显示多次通路失功史(P=0.016)、人造血管通路位置(P=0.005)和术后抗栓治疗(P=0.005)为独立预测因素。AVALG组并发症发生率50%(7/14),上臂和前臂AVG并发症发生率67.9%(57/84),差异无显著性(χ~2=1.689,P=0.194)。结论 AVALG在双上肢动静脉瘘多次失功、双上肢血管资源耗竭的透析患者中具有重要临床应用价值。
[Abstract]:Objective to evaluate the clinical effect of arteriovenous axillary loop graftg (AVALG), and to compare the patency rate and its influencing factors between AVALG and upper arm (forearm, upper arm). Methods from June 2008 to September 2015, the data of end-stage nephropathy in 69 patients with AVG with arteriovenous fistula performed in our department from June 2008 to September 2015 were analyzed retrospectively. There were 44 cases with AVG in forearm and 64 times with AVG in forearm and 14 cases with AVALG in upper arm. Using log-rank test of survival curve, Cox multivariate regression analysis was used to compare the difference of patency rate and complications, and to explore the influencing factors of patency rate. Results the primary patency rates of AVALG in the forearm and AVALG in the upper arm were 59.5% and 43.1%, respectively, and the primary patency rate and secondary patency rate in AVALG were significantly higher than those in the forearm. The secondary patency rates of AVALG were 82.38.9% and 72.568.8%, respectively, and the secondary patency rates of AVALG were significantly higher than those of the forearm, and the secondary patency rates of AVALG were significantly higher than those of the forearm, and the secondary patency rates of AVALG were significantly higher than those of the forearm, and the secondary patency rates of AVALG were significantly higher than those of the forearm. The multivariate analysis of AVGV P0.05N 路Cox showed that the multiple pathway loss (P0.016), the location of artificial vascular pathway (P0. 005) and the postoperative antithrombotic therapy (P0. 005) were independent predictors. The incidence of complications in AVALG group was 50% 714%, and the incidence of AVG in upper arm and forearm AVG was 67.957% 84%. There was no significant difference (蠂 2 1. 689 P 0. 194). Conclusion AVALG has important clinical value in hemodialysis patients with double upper limb arteriovenous fistula.
【作者单位】：北京大学第一医院介入血管外科;
【分类号】：R459.5

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