【摘要】目的探讨2 型糖尿病肾病与非糖尿病肾病患者自体动静脉内瘘术后成熟度的差异，为透析治疗和护理提供参考依据。方法以2017 年1 月～2019 年7 月在常州市第二人民医院血液净化中心行自体动静脉内瘘手术的60 例原发病为糖尿病肾病的患者为观察组，随机选取同时期60 例非糖尿病肾病患者为对照组，术前术后由专业护理人员通过物理性检查并结合彩色多普勒超声评估2 组内瘘成熟度，回顾性分析2 组内瘘的成熟状态及血流动力学参数。结果①观察组内瘘成熟时，平均内瘘成熟时间为(88.25±7.30)d，头静脉平均内径为(4.85±1.31)mm，血流量为(586.49±78.33)ml/min，与对照组比较差异有统计学意义(t=-20.591, P＜0.001；t= 3.385,P=0.001；t=4.667,P＜0.001)。②观察组术前桡动脉内径小于对照组，至成熟期时最终扩张程度也小于对照组，差异有统计学意义(t=2.224,P=0.029；t=-3.134,P=0.002)。对照组术后2 周的头静脉内径和血流量接近成熟期的数值，观察组术后4 周的头静脉内径和血流量才接近成熟期数值。结论糖尿病肾病患者自体动静脉内瘘术后成熟度及血流动力学与非糖尿病患者有差异，准确判断自体动静脉内瘘成熟状态，对于适时开展透析治疗、维持血液透析的顺利开展均有着重要意义。
【Abstract】Objective To study the difference of the maturation of autologous arteriovenous fistula (AVF) between the patients with type 2 diabetic nephropathy and those with non-diabetic nephropathy, and to provide suggestions for dialysis treatment and nursing in these patients. Methods Sixty patients with diabetic nephropathy and treated in the period from January 2017 to July 2019 were recruited as the observation group, and 60 patients with non-diabetic nephropathy in the same period were randomly selected as the control group. Maturation of AVF and hemodynamic parameters of the patients in the two groups were examined by physical examination and color Doppler ultrasound and then analyzed retrospectively. Results ①In observation
group, the average maturation period of AVFs was 88.25±7.30 days, the average internal diameter of cephalic vein was 4.85±1.31 mm, and the average blood flow was 586.49±78.33 ml/min, significantly different from those in control group (t=-20.591, P<0.001 for maturation period; t=3.385, P=0.001 for cephalic vein diameter; t=4.667, P<0.001 for blood flow). ②in observation group, the diameter of radial artery was smaller than that in control group before the surgery (t=2.224, P= 0.029), and remained smaller after maturation (t=-3.134, P=0.002). The periods of internal diameter of cephalic vein and blood flow rate to the maturation values were 2 and 4 weeks in control group and observation group respectively. Conclusion The maturation and hemodynamics of AVF after the surgery are different between patients with diabetic nephropathy and those with non-diabetic nephropathy. These differences are of great significance in accurate determination of the AVF maturity, the time suitable for blood access, and successful performance of hemodialysis.
参考文献
［1］王玉柱，叶朝阳，金其庄．中国血液透析用血管通路专家共识[J]．中国血液净化，2014，13(8)：549—549．
［2］LazichI , ChangA , WatsonS ,etal .Morphometricandhistologi-
calparametersinveinsofdiabeticpatientsundergoingbrachioce-
phalicfistulaplacement [ J ] .HemodialInt , 2015 , 19 ( 4 ): 490-498.
[3]宋 利,符 霞等糖尿病肾病病人自体动静脉内瘘血流动力学改变的研究
护理研究 2017 年 5 月第 31 卷第 13 期(总第 573 期)
［4］Dmber LM，Imrey PB，Beck GJ，et a1．Objectives and Design of the
Hemodialysis Fistula Maturation Study[J]．Am J Kidney Dis，2014，63：104—112．
［5］张倩, 张丽红, 王保兴. 自体动静脉内瘘的物理检查[J]. 中国血液净化, 2012, 11(3): 153-156. DOI: 10.3969/j.issn.1671-4091.2012.03.011.
［6］朱宇莉,丁红,范培丽,等.彩超对维持性血透患者自体动静脉内瘘血流量及血流动力学的监测[J].中国超声医学杂志,2014,30(9):824-826．
［7］Kordzadeh A， Chung J， Panayiotopoulos Y P．Cephalic vein and radial artery diameter in formation of radio cephalic arteriovenous fistula： a systematic review [J] J Vasc Access， 2015， 16(6)：506—511
［8］ Zadeh MK, Negahi A.Factors affecting the maturation of arterio-
venous fistula in patients with end-stage renal disease[J]. Saudi
J Kidney Dis Transpl, 2014,25(1):161-165.
[9] Salmela B, Hartman J, Peltonen S, et al. Thrombophilia and
arteriovenous fistula survival in ESRD[J]. Clin J Am Soc Nephrol,
2013,8(6):962-968. DOI: 10.2215/CJN.03860412.
[10]Brahmbhatt A，Remuzzi A，Franzoni M，et a1．The molecular mechanisms of hemodialysis vascular access failure[J]．Kidney International，2016，89(2)：303-316．
［11］徐元恺，张丽红，张文云，等．自体动静脉内瘘建立后的血管重构及其影响因素［Ｊ］中华肾脏病杂志，2014，30：424-428. DOI:
［12］鄢建军,张仲华,严贺,等.血液透析患者动静脉内瘘栓塞及影响因素研究[J].护理学杂志,2016,31(1):26-28.j.issn.1001-7097.2014.11.007.
［13］米绪华，唐万欣，付平，等．自体动静脉内瘘早期失功及其影响因
素的分析[J]，中国血液净化，2009。8(7)：365—368．
