■自体动静脉瘘(AVF)是首选的血管通路模式。然而,AVF穿刺的最早时间以及过早穿刺是否会影响AVF通畅率仍不清楚.
■在这项多中心回顾性队列研究中,纳入2018年9月1日至2021年8月31日在浙江省台州医院或恩泽医院首次接受AVF手术的成年尿毒症患者.所有患者均在穿刺后随访1年。以及瘘管的建立和穿刺状况,随后的通畅,后续损失,肾移植,转换为腹膜透析,放弃瘘管,和死亡,被记录下来。
■本研究共纳入465例AVF患者,包括59例(12.7%)在30天内插管的瘘管患者。在早期穿刺组中,血清肌酐和尿素氮水平较高,而血红蛋白和白蛋白的水平较低,提示这些患者需要紧急透析.此外,非袖口导管使用率较高,而袖口导管使用率较低,股静脉穿刺优于颈内静脉穿刺。早期穿刺组的平均导管留置时间较短(19天比70天,p<0.001)。在早期穿刺组和对照组中,12个月时估计的AVF主要和累积功能通畅率为81.1%对82.3%和98.3%对98.7%,分别。Kaplan-Meier分析显示,两组之间的AVF原发性和累积功能通畅性没有显着差异。
■在已建立瘘管的患者中,急需血液透析,为了避免新的导管插入,对于血管发育良好的患者,经过充分的超声和临床评估后,可以在30天内进行穿刺,而不会影响瘘管的通畅性.
UNASSIGNED: Autogenous arteriovenous fistula (AVF) is the preferred vascular access mode. However, the earliest possible time for AVF puncture and whether premature puncture affects the AVF patency rate remain unclear.
UNASSIGNED: In this multicenter retrospective cohort study, adult uremic patients who underwent AVF surgery for the first time at Taizhou Hospital or Enze Hospital of Zhejiang Province between September 1, 2018 and August 31, 2021 were enrolled. All patients were followed up for 1 year after puncture, and the status of fistula establishment and puncture, subsequent patency, loss to follow-up, renal transplantation, conversion to peritoneal dialysis, abandonment of the fistula, and death, were recorded.
UNASSIGNED: A total of 465 patients with AVFs were included in this study, including 59 (12.7%) patients with fistulas that were cannulated within 30 days. In the early puncture group, the levels of serum creatinine and urea nitrogen were higher, while the levels of hemoglobin and albumin were lower, suggesting that these patients needed urgent dialysis. Furthermore, the rate of non-cuffed catheter use was higher, while the rate of cuffed catheter use was lower, and femoral vein puncture was preferred over internal jugular vein puncture. The mean duration of catheter indwelling was shorter in the early puncture group (19 vs 70 days, p < 0.001). The estimated AVF primary and cumulative functional patency at 12 months was 81.1% versus 82.3% and 98.3% versus 98.7% in the early puncture and control groups, respectively. Kaplan-Meier analysis revealed no significant difference in AVF primary and cumulative functional patency between the two groups.
UNASSIGNED: In patients with an established fistula in urgent need of hemodialysis, to avoid new catheterization, a puncture can be performed within 30 days in those with well-developed blood vessels after adequate ultrasound and clinical evaluation without affecting the patency of the fistula.