与动静脉瘘通畅相关的特征。荟萃分析。

Dongjuan Zhang, Jing Liang, Yang Yang
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引用次数: 0

摘要

导言:目前尚不清楚首次插管的时间、建立通路的方法、插管技术或针头类型等插管相关变量是否与动静脉瘘的预后有关。我们进行了一项荟萃分析,以研究这些变量与 1 年主要通畅率之间的潜在关联:我们检索并审查了标题中包含 "动静脉瘘"、"通畅"、"插管"、"计量"、"首次插管"、"血液透析"、"并发症"、"血管"、"护理 "和 "穿刺 "的 28 篇文献:1 年初次通畅率从 0.32 到 0.93 不等。与吻合术后 1.5 个月以上首次插管的瘘管相比,瘘管建立后 1.5 个月以内首次插管的患者的初次通畅率明显较低(几率比 [OR] = 0.41,95% 置信区间 [CI]:0.32-0.52)。与金属针相比,在最初两到三个穿刺周内使用塑料插管时,插管时间对初次通畅率的影响会减弱(OR = 0.62 vs. 0.34; p = 0.032)。与前臂瘘管相比,上臂瘘管的 1 年初次通畅率并不更高(OR = 1.05,95% CI:0.93-1.19)。与亚洲的报告相比,美洲或欧洲的报告中上臂动静脉瘘的初次通畅率更高。与绳梯插管相比,扣眼插管与更高的1年通畅率无关(OR = 1.14,95% CI:0.75-1.71):讨论:早期插管与动静脉瘘1年通畅率降低有关。讨论:早期插管与 1 年动静脉瘘通畅率降低有关,在最初 2-3 周使用塑料插管时,这种关联性降低。
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Features associated with arteriovenous fistula patency. A meta-analysis.

Introduction: It is unclear if cannulation-associated variables such as timing of first cannulation, access creation method, cannulation technique, or needle type are associated with the outcomes of arteriovenous fistulas. We conducted a meta-analysis to investigate such potential associations with 1-year primary patency.

Methods: Twenty-eight publications with titles that included "arteriovenous fistula," "patency," "cannulation," "metric," "first cannulation," "hemodialysis," "complication," "vascular," "nursing," and "puncture" were retrieved and reviewed.

Findings: The 1-year primary patency rates ranged from 0.32 to 0.93. Primary patency rates were significantly lower in patients in whom initial cannulation was done less than 1.5 months after fistula creation compared to fistulas first cannulated more than 1.5 months after anastomosis (odds ratio [OR] = 0.41, 95% confidence interval [CI]: 0.32-0.52). The effect of cannulation timing on primary patency rate was attenuated when plastic cannulas were used during the first two to three puncture weeks compared to metal needles (OR = 0.62 vs. 0.34; p = 0.032). Fistulas in the upper arm did not have a higher 1-year primary patency compared to those in the forearm (OR = 1.05, 95% CI: 0.93-1.19). Primary patency of upper arm arteriovenous fistulas was higher in reports from the Americas or Europe compared to reports from Asia. Buttonhole cannulation was not associated with higher patency rates at 1 year compared to rope-ladder cannulation (OR = 1.14, 95% CI: 0.75-1.71).

Discussion: Early cannulation was associated with reduced 1-year arteriovenous fistula patency. This association was reduced when plastic cannulas were used during the initial 2-3 weeks.

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