目的 比较Acuseal人工血管与膨胀型聚四氟乙烯(expanded polytetrafluoron artificial vessel，ePTFE)人工血管在维持性血液透析(maintenance hemodialysis，MHD)患者中的应用效果，为临床使用提供参考。 方法 回顾性分析2019年12月～2020年12月在济南市中心医院肾内科行人工血管动静脉内瘘(arteriovenous graft，AVG)手术的61例患者，按人工血管类型分为观察组(Acuseal组)及对照组(ePTFE组)，通过1年的观察，比较2组患者内瘘首次穿刺时间、中心静脉导管(central venous catheters，CVC)使用、通畅率及并发症。 结果 观察组与对照组手术时间有统计学差异(U =279.000， P =0.024)。2组首次穿刺时间分别为4(3，6)天、31(30，39)天。2组CVC的留置时间有统计学差异 (U =167.000，P＜0.001)，但2组CVC的使用率无明显差别(χ2=0.000，P =1.000)。观察组与对照组6个月初级通畅率分别为54.5%、66.7%，12个月初级通畅率分别为22.7%、38.5%，组间比较无统计学差异 (χ2=0.934，P =0.334； χ2=1.984，P =0.159)，2组6个月累积通畅率分别为90.9%、100%，12个月累积通畅率为81.8%、94.9%，组间比较无统计学差异(χ2=3.629，P =0.057： χ2=2.758，P =0.097)。2组患者的手术后并发症比较差异无统计学意义，但是观察组感染后完全移除人工血管。 结论 Acuseal人工血管允许早期穿刺、具有相似的通畅率，但由于其手术相对困难、感染后整个血管通路的丢弃，反而又增加了CVC的使用，在临床中应该权衡选择。
Objectives To compare the clinical application of Acuseal artificial blood vessel and expanded polytetrafluoroethylene artificial vessel (ePTFE) as the arteriovenous graft (AVG) for hemodialysis access so as to provide reference for clinical use. Methods A retrospective study was performed on 61 patients undergoing AVG surgery in the Department of Nephrology, Jinan Central Hospital from December 2019 to December 2020. They were divided into observation group (Acuseal group) and control group (ePTFE group) according to the type of artificial blood vessel used. The first puncture time of internal fistula, the use of central venous catheter (CVC), patency rate and complications after the operation for one year were compared between the two groups. Results The surgery time was different between observation group and control group (U=279.000, P=0.024). The first puncture time were 4 (3, 6) days and 31 (30, 39) days after the surgery in observation group and control group respectively. CVC indwelling period was different (U=167.000, P＜0.001), but the rate of CVC used was similar (χ2=0.000, P=1.000) between the two groups. The primary patency rate after 6 months was 54.5% in observation group and was 66.7% in control group (χ2=0.934, P=0.334), and the rate after 12 months was 22.7% in observation group and was 38.5% in control group (χ2=1.984, P=0.159), without statistical significances between the two groups. The cumulative patency rate after 6 months was 90.9% in observation group and was 100% in control group (χ2=3.629, P=0.057), and the rate after 12 months was 81.8% in observation group and was 94.9% in control group (χ2=2.758, P=0.097), also without statistical significances between the two groups. Postoperative complications were similar between the two groups. The artificial vessel in observation group was completely removed if it was infected. Conclusion Acuseal artificial blood vessel allows early puncture and has similar patency rate. However, due to the difficulties in surgery, the removal of the whole dialysis pathway after infection leading to the use of CVC, the AVG using Acuseal artificial blood vessel should be carefully weighed in clinical practice.
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