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多单点穿刺技术改善血液透析患者动静脉移植物内瘘结局的回顾性研究

Multiple Single Cannulation Technique Improves the Outcomes of Arteriovenous Graft in Hemodialysis Patients: A Retrospective Study

    摘要
  • 摘要:
    目的  研究多单点穿刺技术（multiple single cannulation technique, MUST）对血液透析患者动静脉移植物内瘘（arteriovenous graft, AVG）临床结局的影响。
    方法  回顾性分析于2018年1月–2021年12月在郑州大学第一附属医院血液净化中心构建AVG患者的临床资料及通路随访资料。按是否采用MUST分为MUST组及非MUST组，对比两组AVG的累积通畅率及并发症情况，并分析AVG采用MUST的影响因素。
    结果  MUST组纳入115个AVG，非MUST组纳入122个AVG。MUST组AVG的1年、2年、3年、4年和5年累积通畅率分别为100%、99.1%、95.2%、85.4%和73.2%，而非MUST组的1年、2年、3年、4年和5年累积通畅率分别为97.5%、92.7%、77.7%、69.7%和50.0%，其中第2年和第3年的差异有统计学意义（P=0.022，P=0.004）。MUST组的标化干预率〔中位数（四分位间距）〕低于非MUST组〔0.46（0.00，0.94） vs. 0.97（0.60，1.59），Z=−5.808，P<0.001〕。标化干预率高于1.0次/患者年的比例在MUST组为24例（20.9%），而非MUST组为60例（49.2%），两组差异有统计学意义（P<0.05）。MUST组有3例（2.6%）AVG合并动脉瘤，而非MUST组为7例（5.7%），两组差异有统计学意义（χ2=20.737，P<0.001）。MUST组有1例（0.9%）AVG合并感染，而非MUST组为6例（4.9%），两组差异无统计学意义。多因素logistic回归分析结果显示，在联盟单位透析〔比值比（odds ratio, OR）=2.713，95%置信区间（confidence interval, CI）：1.698～4.336，P<0.001〕及随访质量优秀（OR=2.189，95%CI：1.221～3.927，P=0.009）为AVG采用MUST穿刺的独立影响因素。
    结论  MUST可以改善AVG的累积通畅率，降低干预频率和动脉瘤发生率，同时不增加感染率。

     

    Abstract:
    Objective  To evaluate the effects of the multiple single cannulation technique (MUST) on the outcomes of arteriovenous graft (AVG).
    Methods  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.
    Results  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 (χ2=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.
    Conclusion  MUST improves the cumulative patency of AVG and decreases the intervention frequency and the incidence of aneurysm without increasing the risk of graft infection.

     

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