中华儿科杂志
中華兒科雜誌
중화인과잡지
Chinese Journal of Pediatrics
2015年
9期
660-664
,共5页
慢性肾功能衰竭%儿童%维持性血液透析%自体动静脉内瘘%成功率%影响因素
慢性腎功能衰竭%兒童%維持性血液透析%自體動靜脈內瘺%成功率%影響因素
만성신공능쇠갈%인동%유지성혈액투석%자체동정맥내루%성공솔%영향인소
End-stage renal disease%Children%Maintenance hemodialysis%Arteriovenous fistula%Success rate%Relevant factors
目的 分析自体动静脉内瘘成形术成功率的影响因素,探索手术成功的预测指标.方法 选择2007年6月-2014年4月在首都医科大学附属北京儿童医院因终末期慢性肾脏病血液透析行自体动静脉内瘘成形术的患儿62例,男性41例,女性21例,患儿手术时年龄中位数为11岁9个月(5岁8个月～16岁2个月).原发病比例前两位为慢性肾小球肾炎18例(29％),肾脏畸形及发育不良17例(27％).以手术后1周在吻合口附近是否有震颤及血管杂音者为手术是否成功的分组标准,分为手术成功组50例(81％),失败组12例(19％).回顾性收集患儿确诊终末期慢性肾脏病时间、手术时间、麻醉方式、血管选择、手术侧别选择,术前血红蛋白、血小板计数、血细胞容积、血肌酐、凝血酶原时间、纤维蛋白原、部分活化凝血酶原时间、Ca2+、总蛋白、白蛋白、尿素氮、甘油三酯、胆固醇、尿酸、高密度脂蛋白、低密度脂蛋白、极低密度脂蛋白、尿蛋白、左心室射血分数,动静脉内瘘吻合口内径,术前、术后3d及手术当天上午和下午6时血压,手术开始时和结束时即刻血压,术中平均血压,术后手术部位震颤及血管杂音等.采用t检验和卡方检验对各因素在两组间的差异进行比较,筛选出有统计学意义的因素,将其纳入多因素logistic回归分析.结果 (1)患儿从确诊终末期慢性肾脏病到手术的平均时间间隔为30.8 d.KIDOQI血管通路指南建议术前准备时间为6～12个月.(2)经t检验和卡方检验筛选出手术成功组与失败组间差异有统计学意义的因素:麻醉方式(x2=5.531,P=0.026)、术前血清胆固醇浓度(t=-2.069,P=0.043)、术前下午平均收缩压(t=2.154,P =0.042)和手术结束时即刻收缩压(t=2.199,P=0.032).多因素logistic回归分析:手术结束时即刻收缩压是手术成功的独立保护因素(OR=0.962,P=0.040,95％CI=0.926 ～0.998),手术结束即刻收缩压每升高1 mmHg(1 mmHg =0.133 kPa),手术失败的风险是0.962倍.结 论患儿从确诊需要进行维持性血液透析到手术实施平均时间为30.8 d,远低于KIDOQI血管通路指南建议的提前6～12个月进行术前准备.手术结束时即刻收缩压是手术成功的保护因素,可作为临床上预测指标之一,升高手术结束时即刻血压可以提高手术成功率.
目的 分析自體動靜脈內瘺成形術成功率的影響因素,探索手術成功的預測指標.方法 選擇2007年6月-2014年4月在首都醫科大學附屬北京兒童醫院因終末期慢性腎髒病血液透析行自體動靜脈內瘺成形術的患兒62例,男性41例,女性21例,患兒手術時年齡中位數為11歲9箇月(5歲8箇月～16歲2箇月).原髮病比例前兩位為慢性腎小毬腎炎18例(29％),腎髒畸形及髮育不良17例(27％).以手術後1週在吻閤口附近是否有震顫及血管雜音者為手術是否成功的分組標準,分為手術成功組50例(81％),失敗組12例(19％).迴顧性收集患兒確診終末期慢性腎髒病時間、手術時間、痳醉方式、血管選擇、手術側彆選擇,術前血紅蛋白、血小闆計數、血細胞容積、血肌酐、凝血酶原時間、纖維蛋白原、部分活化凝血酶原時間、Ca2+、總蛋白、白蛋白、尿素氮、甘油三酯、膽固醇、尿痠、高密度脂蛋白、低密度脂蛋白、極低密度脂蛋白、尿蛋白、左心室射血分數,動靜脈內瘺吻閤口內徑,術前、術後3d及手術噹天上午和下午6時血壓,手術開始時和結束時即刻血壓,術中平均血壓,術後手術部位震顫及血管雜音等.採用t檢驗和卡方檢驗對各因素在兩組間的差異進行比較,篩選齣有統計學意義的因素,將其納入多因素logistic迴歸分析.結果 (1)患兒從確診終末期慢性腎髒病到手術的平均時間間隔為30.8 d.KIDOQI血管通路指南建議術前準備時間為6～12箇月.(2)經t檢驗和卡方檢驗篩選齣手術成功組與失敗組間差異有統計學意義的因素:痳醉方式(x2=5.531,P=0.026)、術前血清膽固醇濃度(t=-2.069,P=0.043)、術前下午平均收縮壓(t=2.154,P =0.042)和手術結束時即刻收縮壓(t=2.199,P=0.032).多因素logistic迴歸分析:手術結束時即刻收縮壓是手術成功的獨立保護因素(OR=0.962,P=0.040,95％CI=0.926 ～0.998),手術結束即刻收縮壓每升高1 mmHg(1 mmHg =0.133 kPa),手術失敗的風險是0.962倍.結 論患兒從確診需要進行維持性血液透析到手術實施平均時間為30.8 d,遠低于KIDOQI血管通路指南建議的提前6～12箇月進行術前準備.手術結束時即刻收縮壓是手術成功的保護因素,可作為臨床上預測指標之一,升高手術結束時即刻血壓可以提高手術成功率.
목적 분석자체동정맥내루성형술성공솔적영향인소,탐색수술성공적예측지표.방법 선택2007년6월-2014년4월재수도의과대학부속북경인동의원인종말기만성신장병혈액투석행자체동정맥내루성형술적환인62례,남성41례,녀성21례,환인수술시년령중위수위11세9개월(5세8개월～16세2개월).원발병비례전량위위만성신소구신염18례(29％),신장기형급발육불량17례(27％).이수술후1주재문합구부근시부유진전급혈관잡음자위수술시부성공적분조표준,분위수술성공조50례(81％),실패조12례(19％).회고성수집환인학진종말기만성신장병시간、수술시간、마취방식、혈관선택、수술측별선택,술전혈홍단백、혈소판계수、혈세포용적、혈기항、응혈매원시간、섬유단백원、부분활화응혈매원시간、Ca2+、총단백、백단백、뇨소담、감유삼지、담고순、뇨산、고밀도지단백、저밀도지단백、겁저밀도지단백、뇨단백、좌심실사혈분수,동정맥내루문합구내경,술전、술후3d급수술당천상오화하오6시혈압,수술개시시화결속시즉각혈압,술중평균혈압,술후수술부위진전급혈관잡음등.채용t검험화잡방검험대각인소재량조간적차이진행비교,사선출유통계학의의적인소,장기납입다인소logistic회귀분석.결과 (1)환인종학진종말기만성신장병도수술적평균시간간격위30.8 d.KIDOQI혈관통로지남건의술전준비시간위6～12개월.(2)경t검험화잡방검험사선출수술성공조여실패조간차이유통계학의의적인소:마취방식(x2=5.531,P=0.026)、술전혈청담고순농도(t=-2.069,P=0.043)、술전하오평균수축압(t=2.154,P =0.042)화수술결속시즉각수축압(t=2.199,P=0.032).다인소logistic회귀분석:수술결속시즉각수축압시수술성공적독립보호인소(OR=0.962,P=0.040,95％CI=0.926 ～0.998),수술결속즉각수축압매승고1 mmHg(1 mmHg =0.133 kPa),수술실패적풍험시0.962배.결 론환인종학진수요진행유지성혈액투석도수술실시평균시간위30.8 d,원저우KIDOQI혈관통로지남건의적제전6～12개월진행술전준비.수술결속시즉각수축압시수술성공적보호인소,가작위림상상예측지표지일,승고수술결속시즉각혈압가이제고수술성공솔.
Objective To analyze the factors relevant to success rate of arteriovenous fistula (AVF) plasty in children who need maintenance hemodialysis and to provide predictor of the success of operation.Method Totally 62 patients who had arteriovenous fistula plasty operation for maintenance of hemodialysis in our hospital treated during June 2007 to April 2014 were enrolled into this study,41 were male,and 21 female,median age of surgery was 11 years and 9 months (age range was 5 y 8 m to 16 y 2 m).The proportions of primary diseases were:chronic glomerulonephritis 29％ (18),kidney abnormality and dysplasia 27％ (17).These 62 cases were divided into 2 groups:the success group and the failure group according to whether there were tremble and vascular murmur on the surgery site 1 week after the surgery.Factors like sex,choice of operation side,choice of operation vessel,anesthesia,urine protein,model of vascular suture line,age of surgery,inner diameter of anastomotic stoma,hemoglobin (Hb),platelet (Plt),hematocrit (Hct),coagulation function (prothrombin time,PT,fibrinogen,Fib,activated partial thromboplastin time,APTT),creatinine (Scr),Ca2+,left ventricular ejection fraction (LVEF),blood pressure (before,during and after sugery) were collected retrospectively.Student's t test and chi-square tests were used to analyze the differences of the factors between 2 groups.Those factors which were statistically significant in t test and chi-square test were taken into multi factor logistic regression analysis.Result (1) Average time interval from final diagnosis of ESRD to surgery was 30.8 days.(2) Relevant factors of operation success rate:anesthesia (x2 =5.531,P =0.026),preoperative serum cholesterol (CHO) (t =-2.069,P =0.043),mean systolic blood pressure in the afternoon before operation (t =2.154,P =0.042),systolic blood pressure when the operation was finished(t =2.199,P =0.032) were related to the success rate of AVF operation in the t test and chi-square test.Multi factors logistic regression analysis showed systolic blood pressure measured when the operation was finished was a dependent protective factor of the surgery(OR =0.962,P =0.040,95％ CI =0.926-0.998).When the systolic blood pressure at the end of operation elevated 1 mmHg(1 mmHg =0.133 kPa),the failure rate of the surgery would be 0.962 times.Conclusion The time interval from final diagnosis of ESRD to surgery was 30.8 days,it was much shorter than 6-12 months which was suggested by 2006 NKF-KDOQI vascular access guideline.As dependent protective factor of success rate,the systolic blood pressure at the end of operation was suggested to be the predictor of successful operation.And the higher systolic blood pressure at the end of operation may increase the success rate of operation.
