维持性血液透析动静脉内瘘并发症防治

    Treatment of arteriovenous fistula complications in patients receiving maintenance hemodialysis

    • 摘要: 目的:探讨维持性血液透析患者自体动静脉内瘘主要并发症及治疗效果。方法:对319例维持性血液透析患者内瘘手术要点、穿刺方法、主要并发症及治疗方法进行分析。结果:319例内瘘主要在非优势侧前臂行端-端吻合、采用"扣状和绳梯式穿刺法"穿刺。并发症发生率最高的是血栓(26%),主要有吻合口血栓(19.7%)、穿刺部位附壁血栓(6.3%),其次是血管通路狭窄发生率(10.3%)(包括吻合口、静脉解剖本身存在的狭窄、穿刺部位狭窄);第三位是血管瘤,发生率3.8%(主要发生在吻合口及穿刺部位)。319例中234例使用3年以上。结论:造成维持性血液透析患者自体动-静脉内瘘血管通路失功的三个原因,依次是血栓、狭窄、血管瘤。手术治疗仍然是纠正血管通路并发症最有效的治疗方法。

       

      Abstract: Objective: To explore the procedures for treatment of complications of arteriovenous fistula in patients receiving maintenance hemodialysis.Methods: Three hundred and nineteen patients receiving maintenance hemodialysis were included in the study.The fistula surgery,puncture process,main complications and treatment procedures were analyzed.Results: The arterioveneous fistula in all the 319 case was built mainly by terminal-terminal anastomosis in the unaccustomedly-used forearm with "button-like and ladder-type puncture".The most common complications were thrombus (26%) including anastomotic thrombosis (19.7%) and puncture site mural thrombus (6.3%),vascular access stenosis (10.3%) including anastomotic stenosis,vein anatomy inherent stenosis and narrow puncture site,and hemangioma which mainly occurred in the stoma and the puncture site (3.8%).Of the 319 fistula,234 were used for more than 3 years.Conclusions: The reasons for fistula vascular access dysfunction in maintenance hemodialysis patients are thrombus,stenosis and hemangioma in sequence,and surgery is the most effective therapy for complications of vascular access.

       

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