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目的:探讨4种不同部位动静脉内瘘对老年尿毒症血液透析患者的疗效影响。方法:选取2007年5月—2010年4月收治的152例老年肾衰竭尿毒症患者,采用显微外科技术建立动静脉内瘘,根据建立部位的不同分为鼻烟窝内瘘组37例、腕部内瘘组42例、上肢前臂内瘘组36例和上臂肱动脉内瘘组37例,比较各组不同时间的内瘘血流量、通畅率及并发症等。结果:上臂肱动脉内瘘组的内瘘血流量最高,达(334.56±71.52)m L/min,明显高于鼻烟窝内瘘组、腕部内瘘组和上肢前臂内瘘组,差异有统计学意义(P<0.01);各组动静脉内瘘的成熟时间、开始应用时间比较无统计学差异(P>0.05);在血流通畅方面,4组1个月通畅率无统计学差异(P>0.05),但上臂肱动脉内瘘组1、2、3年的通畅率均明显低于其余3组(均P<0.05);上臂肱动脉内瘘组3年内血栓形成、充血性心力衰竭、假性动脉瘤发生率较其余3组呈明显上升趋势(均P<0.05)。结论:若患者血管条件允许情况下,建立鼻烟窝内瘘是老年尿毒症血液透析的患者首选部位,血管条件普遍较差选用上臂肱动脉内瘘时,需密切留意后期通畅率和并发症情况。
Objective: To investigate the effect of arteriovenous fistula (FV) at four different sites on hemodialysis patients with senile uremia. Methods: A total of 152 elderly patients with renal failure and uremia who were admitted to our hospital from May 2007 to April 2010 were enrolled in this study. Microsurgical techniques were used to establish arteriovenous fistula. According to the site of establishment, 37 cases were divided into three groups: 42 cases of intra-fistula group, 36 cases of upper extremity fistula group and 37 cases of upper-arm brachial artery fistula group. The fistula blood flow, patency rate and complications at different time were compared. Results: The fistula blood flow in the upper arm brachial fistula group was the highest (334.56 ± 71.52) m L / min, which was significantly higher than that of snuff fistula group, wrist fistula group and upper arm forearm fistula group, the difference was statistically significant (P <0.01). There was no significant difference in the maturation time of arteriovenous fistula between the two groups (P> 0.05). There was no significant difference in patency between the four groups > 0.05). However, the patency rates at 1, 2 and 3 years in the upper arm brachial artery fistula group were significantly lower than those in the remaining 3 groups (all P <0.05). Thrombus formation, congestive heart failure, The incidence of pseudoaneurysm was significantly higher than the other three groups (all P <0.05). Conclusion: If the patient’s vascular conditions permit, the establishment of nasal fistula fistula is the preferred site of hemodialysis in elderly patients with uremia, generally poor vascular conditions, the choice of upper brachial artery fistula, the need to pay close attention to late patency rate and complications.