摘要
目的比较即穿型人造血管与肝素涂层人造血管在维持性血液透析患者建立动静脉内瘘中的长期效果。方法选择自2016年10月1日~2017年12月31日于北京市海淀医院(北京大学第三医院海淀院区)行人造血管内瘘成形术的患者,按选用血管类型分为即穿型人造血管组(观察组)及肝素涂层组(对照组),比较2组患者内瘘首次穿刺时间、通畅率及通路相关并发症发生情况。结果入组患者120例,其中观察组45例,对照组75例,2组患者在年龄、性别、原发病、透析龄、用药情况、相关化验指标及吻合血管内径差异无统计学意义。与对照组相比观察组平均穿刺时间短(t=0.682, P<0.001);6个月、12个月原发通畅率低(x^2值分别为6.645, 8.632;P值分别为0.018,0.004);6个月、12个月原发辅助通畅率低(x^2值分别为14.665,10.371;P值分别为<0.001,0.001);观察组与对照组6个月,12个月累积通畅率分别为91.11%,88.89%和100%, 94.67%,,12个月累积通畅率差别无统计学差异(x^2=1.354 P=0.293)。2组间感染、通路相关缺血、假性动脉瘤等方面差别无统计学意义。观察组4例有人造血管分层现象。结论即穿型人造血管允许早期穿刺,但其原发通畅及原发辅助通畅较肝素涂层人造血管低,在临床应用需权衡利弊进行选择。
Objective To compare the performance of self-sealing vascular access graft(Acuseal) and heparin-bonded graft(Propaten) in hemodialysis applications. Methods The end stage renal disease patients undergoing implantation of prosthetic graft in Haidian Hospital from October 1 st, 2016 to December 31 st,2017 were enrolled in this retrospective study. According to the graft type, patients were divided into Acuseal group(observation group) and Propaten group(control group). Early cannulation time, survival rate and access related complications were compared between the two groups. Results There were no statistical differences in age, gender, primary disease, age of dialysis, drugs used, laboratory results and the inner diameter of the anastomotic vessels between observation group(n=45) and control group(n=75). Compared with control group, patients in observation group had shorter early cannulation time(3.0±2.53 days vs. 54.08±23.73 days,P=0.000), lower primary survival rates after 6 months and 12 months(60% and 37.78% vs. 81.33% and65.33%, P=0.018 and 0.004), lower primary assisted survival rates after 6 months and 12 months(68.89% and55.56% vs. 94.67% and 82.67%, P=0.00 and 0.001). The cumulative survival rates after 6 months and 12 months in observation group and control group were 91.11% and 88.89% vs. 100% and 94.67%(P=0.293).Access-related complications such as infection, ischemia and pseudoaneurysm were similar in both groups, except 4 cases with layer separation in graft in observation group. Conclusion Acuseal graft allows for early blood access, but its primary survival rate and primary assisted survival rate are lower. The pros and cons should be considered during the selection of prosthetic grafts.
作者
张丽红
詹申
肖光辉
王玉柱
ZHANG Li-hong;ZHAN Shen;XIAO Guang-hui;WANG Yu- zhu(Department of Nephrology, Haidian Hospital (Beijing Haidian Section of Peking University Third Hospital), Beijing 100080, China)
出处
《中国血液净化》
CSCD
2019年第10期701-704,共4页
Chinese Journal of Blood Purification
基金
2017年北京市海淀医院院级基金项目(编号：KMY2017003)
