【摘要】目的 探讨老年维持性血液透析患者不同手术部位对自体动静脉内瘘通畅率的影响。 方法 回顾性研究老年与非老年患者首次于前臂远端或近端建立自体动静脉内瘘的通畅率；比较老年糖尿病与非糖尿病患者建立自体动静脉内瘘的通畅率。结果 老年与非老年组患者不同部位建立内瘘后3月到48月的通畅率无统计学差异。老年组于前臂远端建立内瘘后3-24月通畅率均高于前臂近端(2=7.699，P=0.022；2=6.460，P=0.026；2=8.271，P=0.009；2=4.643，P=0.031)。老年糖尿病组内瘘术后36-48月通畅率低于非糖尿病组(2=5.963，P=0.015；2=27.388，P=0.000)。 结论 老年维持性血液透析患者于前臂远端部位建立自体动静脉内瘘具有良好的通畅率，认可作为首选部位，糖尿病影响老年维持性血液透析患者自体动静脉内瘘的远期通畅率。
【Abstract】 Objective To investigate the effects of autogenous arteriovenous fistula (AVF) at different incision site on patency rate in elderly maintenance hemodialysis patients. Methods A retrospective analysis was made to compare the patency rate of autogenous AVF at lower part of forearm or upper part of forearm between elderly and non-elderly hemodialysis patients. We also compared the patency rate of autogenous AVF between diabetic and non-diabetic elderly patients. Results There was no statistical difference between elderly patients and non-elderly patients in patency rate within 3-48 months after AVF operation. In elderly patients, the patency rate within 3-24 months after operation was higher in AVFs at lower part of forearm than those at upper part of forearm (X2=7.699, P=0.022; X2=6.460, P=0.026; X2=8.271, P=0.009; X2=4.643, P=0.031), the patency rate within 36-48 months after operation was lower in AVFs in diabetic patients than those in non-diabetic patients(X2=5.963, P=0.015; X2=27.388, P=0.000). Conclusion Autogenous AVF at lower part of forearm gives higher patency rate, and is preferable to be used in elderly maintenance hemodialysis patients. Diabetes affects the long-term patency rate of autogenous AVF in these patients.
