■评估多次单插管技术(MUST)对动静脉移植物(AVG)结局的影响。
■对2018年1月至2021年12月在郑州大学第一附属医院创建的AVG进行了回顾性研究。分析患者的临床资料及其静脉通路的随访资料。根据是否使用MUST将受试者分为MUST组和非MUST组。比较两组患者的累积通畅率和并发症发生率。采用Logistic回归分析AVG应用MUST的影响因素。
■必须组包括115AVG和非必须组,122AVG。1年,2年,3年,MUST组的4年累积通畅率为100%,99.1%,95.2%,85.4%,73.2%,分别,而非必须组则为97.5%,92.7%,77.7%,69.7%,50.0%,分别,2年和3年通畅率差异有统计学意义(P=0.022,P=0.004)。MUST组以(中位数[四分位距])表示的标准干预率明显低于非MUST组(0.46[0.00,0.94]vs.0.97[0.60,1.59],Z=-5.808,P<0.001)。MUST组共24例(20.9%)AVG和非MUST组60例(49.2%)AVG的标准干预率>1.0/患者年,两组之间具有显著差异。MUST组有3例(2.6%)AVG,非MUST组有7例(5.7%)AVG合并动脉瘤(χ2=20.737,P<0.001)。MUST组1例(0.9%)AVG和非MUST组6例(4.9%)AVG有移植物感染,组间差异无统计学意义(P=0.121)。多因素logistic回归显示联盟设施透析(比值比[OR]=2.713,95%置信区间[CI]:1.698-4.336,P<0.001],随访良好[OR=2.189,95%CI:1.221~3.927,P=0.009]是AVG应用MUST的影响因素。
■必须改善AVG的累积通畅性,并在不增加移植物感染风险的情况下降低介入频率和动脉瘤的发生率。
UNASSIGNED: To evaluate the effects of the multiple single cannulation technique (MUST) on the outcomes of arteriovenous graft (AVG).
UNASSIGNED: A retrospective study of AVG created between January 2018 and December 2021 at the First Affiliated Hospital of Zhengzhou University was conducted. The clinical data of patients and their follow-up data for venous access were analyzed. Subjects were divided into the MUST group or the non-MUST group according to whether MUST was used. The cumulative patency rate and complication incidence were compared between the two groups. Logistic regression was applied to analyze the influencing factors of applying MUST in AVG.
UNASSIGNED: The MUST group included 115 AVG and the non-MUST group, 122 AVG. The 1-year, 2-year, 3-year, and 4-year cumulative patency rates of the MUST group were 100%, 99.1%, 95.2%, 85.4%, and 73.2%, respectively, while those for the non-MUST group were 97.5%, 92.7%, 77.7%, 69.7%, and 50.0%, respectively, with the 2-year and 3-year patency rates showing significant difference (P=0.022, P=0.004). The standard intervention rate expressed in (median [interquartile range]) in the MUST group was significantly lower than that in the non-MUST group (0.46 [0.00, 0.94] vs. 0.97 [0.60, 1.59], Z=-5.808, P<0.001). A total of 24 (20.9%) AVG in the MUST group and 60 (49.2%) AVG in the non-MUST group had a standard intervention rate >1.0 per patient-year, with significant difference between the two groups. Three (2.6%) AVG in the MUST group and 7 (5.7%) AVG in the non-MUST group were complicated by aneurysm (χ 2=20.737, P<0.001). One (0.9%) AVG in the MUST group and 6 (4.9%) AVG in the non-MUST group had graft infection, with the difference between the groups showing no significance (P=0.121). Multivariate logistic regression showed that dialysis in the alliance facilities (odds ratio [OR]=2.713, 95% confidence interval [CI]: 1.698-4.336, P<0.001], and excellent follow-up [OR=2.189, 95% CI: 1.221-3.927, P=0.009] were the influencing factors of applying MUST in AVG.
UNASSIGNED: MUST improves the cumulative patency of AVG and decreases the intervention frequency and the incidence of aneurysm without increasing the risk of graft infection.