2018年至2022年西爪哇末期肾病患者血管通路插管并发症的特征:一项回顾性观察研究

T. Djajakusumah, Putie Hapsari, Prapanca Nugraha, Arrayyan Muhammad, Kiki Lukman
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摘要

背景终末期肾病(ESKD)带来了巨大的经济负担。印度尼西亚的数据显示,每年越来越多的终末期肾病患者将血液透析作为常规治疗手段。建立和维护血管通路对 ESKD 的治疗非常重要。因血液透析而引起的血管并发症很常见,也是住院治疗的主要原因之一。插管并发症从轻微血肿到需要紧急手术治疗的假性动脉瘤急性出血不等。本研究旨在评估 ESKD 患者血管通路插管并发症的不同临床病理特征以及与并发症相关的手术治疗。材料和方法 本研究为回顾性观察研究。研究对象为印度尼西亚西爪哇省一家三级医院血管和血管内外科的 ESKD 患者。共有 121 名研究对象。从病历中提取了血管插管并发症的临床病理特征和手术治疗方法。结果 三种主要的血管并发症是假性动脉瘤破裂 64/121(52.9%)、假性动脉瘤即将破裂 28/121(23.1%)和假性动脉瘤 21/121(17.4%)。常见的手术方法是结扎引流静脉 47/121(38.8%)、动脉原发性修补术 28/121(23.1%)和动脉补片修补术 18/121(14.9%)。假性动脉瘤破裂出血症状与假性动脉瘤隆起肿块之间存在明显关系(P = 0.001)。血管肿块直径、血管缺损大小和血肿与采取的手术方式之间存在明显关系(P < 0.010)。结论 血管破裂、即将破裂和假性动脉瘤是 ESKD 患者血管通路的主要并发症,所采取的手术方式与血管肿块、缺损和血肿的大小有明显关系。
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Characteristics of Vascular Access Cannulation Complications in End Stage Kidney Disease Patients in West Java from 2018 to 2022: A Retrospective Observational Study
Background End-stage kidney disease (ESKD) is associated with a tremendous financial burden. Data in Indonesia shows an increasing number of patients with ESKD taking hemodialysis as a routine procedure every year. Establishment and maintenance of vascular access are important in the management of ESKD. Vascular complications that often arise due to hemodialysis are common and one of the main reasons for hospitalization. Cannulation complications ranged from minor hematomas to acute bleeding from pseudoaneurysms that required emergency surgical procedures. This study aims to assess the different clinicopathological characteristics of ESKD patients with vascular access cannulation complications and the surgical management related to the complications. Materials and Methods This research is a retrospective observational study. The research subjects in this study were ESKD patients in the vascular and endovascular surgery division of the tertiary hospital in West Java, Indonesia. There were 121 study subjects. Clinicopathological characteristics of vascular cannulation complications and surgical management are extracted from the medical record. Results Three major vascular complications were ruptured pseudoaneurysms 64/121 (52.9%), impending rupture pseudoaneurysms 28/121 (23.1%), and pseudoaneurysms 21/121 (17.4%). Common surgical procedures were ligation of the draining vein 47/121 (38.8%), arterial primary repair 28/121 (23.1%), and arterial patch repair 18/121 (14.9%). There was a significant relationship between symptoms of bleeding in ruptured pseudoaneurysms and bulging masses in pseudoaneurysms (p = 0.001). There was a significant relationship between the diameter of the vascular mass, vascular defect size, and hematoma and the type of surgical procedure taken (p < 0.010). Conclusion Ruptured, impending rupture, and pseudoaneurysms are major complications of vascular access in ESKD patients, and there was a significant relationship between the carried-out surgical procedure and the size of the vascular mass, defect, and hematoma.
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