摘要
目的研究静脉内径对于初次自体动静脉内瘘成形术手术成功率的影响。方法采用回顾性研究,选取2023年1月—8月在四川省人民医院住院治疗的患者,所有患者均第一次行自体动静脉内瘘成形术,且内瘘均为位于前臂的头静脉-桡动脉型内瘘,吻合方式均采用端侧吻合,收集患者的一般资料、实验室检查数据、血管超声、内瘘手术相关资料等,根据手术结果将患者分为手术成功组及手术失败组,对比两组之间资料的差异。采用Logistic回归分析初次动静脉内瘘手术成功率的影响因素,绘制受试者工作特征曲线,评估影响因素对于初次动静脉内瘘成形术手术成功的预测价值。结果共纳入研究对象170例,其中手术成功组151例,手术失败组19例,两组患者在年龄、身高、体重、BMI值、血红蛋白、白蛋白、尿素、肌酐、尿酸、血钙、血磷、CRP、BNP、APTT、PT、动脉内径等方面未见明显差异(P>0.05),在血小板、静脉内径等方面存在统计学差异(P<0.05)。多因素Logistic回归分析结果提示,血小板(OR=0.993,95%CI 0.987~0.998,P=0.013)、静脉内径(OR=4.719,95%CI 1.742~12.782,P=0.002)是手术成功的独立影响因素。ROC曲线显示静脉内径(AUC=0.705,95%CI 0.583~0.827,P=0.004,截断值=0.215 cm)是预测手术成功的重要指标。结论静脉内径是预测初次动静脉内瘘成形术手术成功的重要影响因素,行动静脉内瘘成形手术术前评估时应重视静脉内径的大小。
Objective To investigate the influence of venous diameter on the success of autogenous arteriovenous fistula(AVF)plasty.Methods A retrospective study was conducted on patients hospitalized in Sichuan Provincial People's Hospital from January 2023 to August 2023.All patients underwent their first autogenous arteriovenous fistula plasty,with the AVF located in the forearm involving the cephalic vein and radial artery.End-to-side anastomosis technique was used for all patients.The general data,laboratory data,vascular ultrasound and AVF operation records were collected.Based on the result of autogenous arteriovenous fistula plasty,patients were divided into the surgical success group and the surgical failure group,and their data were compared.Logistic regression analysis was used to identify factors influencing the success of arteriovenous fistula plasty.Receiver operating characteristic(ROC)curves were constructed to evaluate the predictive value of each influencing factor for arteriovenous fistula plasty.Results A total of 170 patients were included in the study,with 151 patients in the surgical success group and 19 patients in the surgical failure group.There were no significant differences between the two groups in terms of age,height,weight,BMI,hemoglobin,albumin,urea,creatinine,uric acid,calcium,phosphate,C-reactive protein,brain natriuretic peptide,prothrombin time,AVF anastomosis size,or arterial diameter(P>0.05).However,statistically significant differences were found in terms of platelet count and venous diameter(P<0.05).Multivariable Logistic regression analysis revealed that platelet count(OR=0.993,95%CI 0.987-0.998,P=0.013)and venous diameter(OR=4.719,95%CI 1.742-12.782,P=0.002)were independent influencing factors for surgical success.ROC curve analysis showed that venous diameter(AUC=0.705,95%CI 0.583-0.827,P=0.004,cut-off value=0.215 cm)was an important indicator for predicting surgical success.Conclusion Venous diameter is an important factor for predicting the success of arteriovenous fistula plasty.Therefore,careful consideration should be given to venous diameter during the preoperative evaluation of arteriovenous fistula plasty.
作者
马石杰
杨薇
康宇薇
罗旭阳
范译
牛思彧
邓菲
MA Shijie;YANG Wei;KANG Yuwei;LUO Xuyang;FAN Yi;NIU Siyu;DENG Fei(Department of Nephrology,School of Medicine,University of Electronic Science and Technology of China,Sichuan Academy of Medical Sciences,Sichuan Provincial People's Hospital,Chengdu 610072,China;Department of Nephrology,The Affiliated Hospital of Southwest Medical University,Luzhou 646000,Sichuan,China;Department of Nephrology,The Affiliated Hospital of North Sichuan Medical College,Nanchong 637000,Sichuan,China;Surgical Anesthesia Center,Jinniu Hospital of Sichuan Provincial People's Hospital,Jinniu District People's Hospital,Chengdu 610000,China;Department of Nephrology,Xinjin District People's Hospital,Chengdu 6114304,China)
出处
《西部医学》
2025年第9期1338-1342,共5页
Medical Journal of West China
基金
四川省老年医学临床医学研究中心开放课题(24LNYXSSA01)
四川省成都市金牛区医学科研课题(JNKY2024-49)。
关键词
动静脉内瘘成形术
血液透析
静脉内径
血管通路
终末期肾脏病
Autogenous arteriovenous fistula plasty
Hemodialysis
Venous diameter
Vascular access
End-stage renal disease
