【摘要】目的探讨穿静脉内瘘手术方法以及在老年血液透析患者中的应用效果。方法回顾性分析2017 年1 月～2019 年12 月海军特色医学中心收治的行自体动静脉内瘘术的老年(年龄＞65 岁)血液透析患者，年龄(75.7±8.9)岁，分为观察组(穿静脉内瘘术，n=48)和对照组(肘上高位动静脉内瘘术，n=54)，比较2 组患者的一般资料、一次性内瘘成功率、内瘘成熟时间以及内瘘血流量，同时随访观察患者手术后通畅率及并发症。结果2 种手术方式一次性成功率均为100%。通畅率方面，对于糖尿病透析患者，早期即可发生内瘘失功，对照组糖尿病患者内瘘生存率低于观察组糖尿病患者(c2=6.971,P=0.008)；对照组非糖尿病患者与观察组非糖尿病患者之间比较，生存率的差异无统计学意义(c2=0.668, P=0.414)。观察组患者的假性动脉瘤和心力衰竭的发生率低于对照组(c2值分别为5.768，7.761；P 值分别为0.014 和0.007)；在血栓形成和肿胀手综合征的发生率方面，2 组比较差异无统计学意义(c2值分别为0.956，0.260；P 值分别为0.248 和0.698)。结论对于腕部及前臂中段血管条件差的老年血液透析患者，行穿静脉内瘘术可获得满意的应用效果。
【Abstract】Objective The purpose of this paper is to assess the establishment methods and clinical application of perforating vein fistula in elderly hemodialysis patients. Methods A retrospective comparison of elderly patients(75.7±8.9years) undergoing primary vascular access surgery using high arteriovenous fistula (n=54) and perforating vein fistula (n=48) was performed over a 3year period. The general data of patients , procedure success rate, fistula maturation time, blood flow during dialysis, postoperative patency rate and complications of patients with different surgical methods were analyzed. Results The two surgical methods have a one-time success rate of 100%. For elderly diabetic dialysis patients, internal fistula failure can occur in the early stage, patency rates were significantly lower in patients withforearm AVF compared to perforating vein AVF (c2= 6.971, P= 0.008). Comparing the non- diabetic patients oftwo group, there were no significant differences in survival rate (c2= 0.668, P= 0.414). The incidence of pseudoaneurysm and heart failurein observation group was significantly lower than in control group (c2= 5.768, 7.761; P= 0.014, 0.007). There were no significant differences between two groups in thrombosisandswollen hand syndrome (c2=0.956, 0.260; P=0.248, 0.698). Conclusion For the elderly patients with poor vascular condition in wrist and forearm, perforating vein fistula operation may have clinically satisfactory efficacies.
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