中国医师进修杂志
中國醫師進脩雜誌
중국의사진수잡지
CHINESE JOURNAL OF POSTGRADUATES OF MEDICINE
2013年
24期
7-10
,共4页
肾病%动静脉瘘%肾透析
腎病%動靜脈瘺%腎透析
신병%동정맥루%신투석
Nephrosis%Arteriovenous fistula%Renal dialysis
目的 探讨终末期肾病患者初次自体动静脉内瘘(AVF)手术失败的原因及预防措施.方法 选取行初次自体AVF手术的终末期肾病患者819例,收集患者术前血红蛋白(Hb)、白蛋白(ALB)、胆固醇(CHOL)、甲状旁腺素(PTH)、空腹血糖以及血压情况,同时在术前行上肢血管超声,检测患者桡动脉和头静脉内径.结果 742例患者AVF手术成功,77例患者AVF手术失败,AVF手术失败患者年龄、糖尿病、高血压、血压＜120/70 mm Hg(1 mm Hg=0.133 kPa)比例显著高于AVF手术成功患者[(61.3±13.4)岁比(45.6±11.2)岁、46.8％(36/77)比31.7％(235H42)、26.0％(20/77)比19.5％ (145/742)、36.4％ (28/77)比9.2％ (68/742)],差异有统计学意义(P ＜0.05或＜0.01)；AVF手术失败患者头静脉、桡动脉内径显著低于AVF手术成功患者[(1.35±0.64) mm比(1.98±0.47) mm、(2.13±0.81) mm 比(2.47±0.74) mm],差异有统计学意义(P＜0.01)；AVF手术失败患者PTH水平显著高于AVF手术成功患者[(782.39±423.85) ng/L比(378.83±352.21)ng/L],差异有统计学意义(P＜0.05).Logistic多元线性回归分析显示血压、糖尿病、PTH、头静脉内径、桡动脉内径是AVF手术失败的危险因素.结论 自体AVF手术失败与患者血压、原发病、需要吻合的血管内径、PTH水平有一定相关性.
目的 探討終末期腎病患者初次自體動靜脈內瘺(AVF)手術失敗的原因及預防措施.方法 選取行初次自體AVF手術的終末期腎病患者819例,收集患者術前血紅蛋白(Hb)、白蛋白(ALB)、膽固醇(CHOL)、甲狀徬腺素(PTH)、空腹血糖以及血壓情況,同時在術前行上肢血管超聲,檢測患者橈動脈和頭靜脈內徑.結果 742例患者AVF手術成功,77例患者AVF手術失敗,AVF手術失敗患者年齡、糖尿病、高血壓、血壓＜120/70 mm Hg(1 mm Hg=0.133 kPa)比例顯著高于AVF手術成功患者[(61.3±13.4)歲比(45.6±11.2)歲、46.8％(36/77)比31.7％(235H42)、26.0％(20/77)比19.5％ (145/742)、36.4％ (28/77)比9.2％ (68/742)],差異有統計學意義(P ＜0.05或＜0.01)；AVF手術失敗患者頭靜脈、橈動脈內徑顯著低于AVF手術成功患者[(1.35±0.64) mm比(1.98±0.47) mm、(2.13±0.81) mm 比(2.47±0.74) mm],差異有統計學意義(P＜0.01)；AVF手術失敗患者PTH水平顯著高于AVF手術成功患者[(782.39±423.85) ng/L比(378.83±352.21)ng/L],差異有統計學意義(P＜0.05).Logistic多元線性迴歸分析顯示血壓、糖尿病、PTH、頭靜脈內徑、橈動脈內徑是AVF手術失敗的危險因素.結論 自體AVF手術失敗與患者血壓、原髮病、需要吻閤的血管內徑、PTH水平有一定相關性.
목적 탐토종말기신병환자초차자체동정맥내루(AVF)수술실패적원인급예방조시.방법 선취행초차자체AVF수술적종말기신병환자819례,수집환자술전혈홍단백(Hb)、백단백(ALB)、담고순(CHOL)、갑상방선소(PTH)、공복혈당이급혈압정황,동시재술전행상지혈관초성,검측환자뇨동맥화두정맥내경.결과 742례환자AVF수술성공,77례환자AVF수술실패,AVF수술실패환자년령、당뇨병、고혈압、혈압＜120/70 mm Hg(1 mm Hg=0.133 kPa)비례현저고우AVF수술성공환자[(61.3±13.4)세비(45.6±11.2)세、46.8％(36/77)비31.7％(235H42)、26.0％(20/77)비19.5％ (145/742)、36.4％ (28/77)비9.2％ (68/742)],차이유통계학의의(P ＜0.05혹＜0.01)；AVF수술실패환자두정맥、뇨동맥내경현저저우AVF수술성공환자[(1.35±0.64) mm비(1.98±0.47) mm、(2.13±0.81) mm 비(2.47±0.74) mm],차이유통계학의의(P＜0.01)；AVF수술실패환자PTH수평현저고우AVF수술성공환자[(782.39±423.85) ng/L비(378.83±352.21)ng/L],차이유통계학의의(P＜0.05).Logistic다원선성회귀분석현시혈압、당뇨병、PTH、두정맥내경、뇨동맥내경시AVF수술실패적위험인소.결론 자체AVF수술실패여환자혈압、원발병、수요문합적혈관내경、PTH수평유일정상관성.
Objective To explore the reasons of the failure of primary arteriovenous fistula (AVF)surgery and the preventive measures in patients with end-stage renal disease.Methods A total of 819patients with end-stage renal disease who accepted primary AVF surgery were selected.The data of hemoglobin (Hb),albumin (ALB),cholesterol (CHOL),parathyroid hormone (PTH),fasting blood glucose and blood pressure were collected before surgery,while the diameters of radial artery and cephalic vein were measured by upper extremity vascular ultrasound.Results Seven hundred and forty-two patients with AVF surgery were successful,and 77 patients were failed.The age,the ratio of diabetes,hypertension and blood pressure ＜ 120/70 mm Hg (1 mm Hg =0.133 kPa) in AVF failed patients was higher than that in AVF successful patients[(61.3 ± 13.4) years vs.(45.6 ± 11.2) years,46.8％(36/77) vs.31.7％ (235/742),26.0％ (20/77) vs.19.5％ (145/742),36.4％ (28/77) vs.9.2％ (68/742)],and there was significant difference (P＜0.05 or ＜0.01).The diameters of radial artery and cephalic vein in AVF failed patients was lower than that in AVF successful patients [(1.35 ± 0.64) mm vs.(1.98 ± 0.47) mm,(2.13 ± 0.81)mm vs.(2.47 ± 0.74) mm],and there was significant difference (P＜ 0.01).The level of PTH in AVF failed patients was higher than that in AVF successful patients [(782.39 ± 423.85) ng/L vs.(378.83 ± 352.21) ng/L],and there was significant difference (P ＜ 0.05).Logistic regression analysis showed that blood pressure,diabetes,PTH,the diameters of radial artery and cephalic vein was the risk factor of AVF failed.Conclusion AVF surgery failed is highly correlated with the patient s blood pressure,th primary disease,the vessel diameter,
