动静脉内瘘闭塞原因分析与护理措施

论文编号:HL127  论文字数:8627.页数:15

论文题目：动静脉内瘘闭塞原因分析与护理措施
摘 要
 目的：随着患者透析龄的延长、人口老龄化以及糖尿病、高血压、周围血管疾病的发病率逐年增加，自体动静脉内瘘的建立愈加困难，其相关并发症也越来越多，部分内瘘吻合失败是长期透析病人面临的主要问题。本文通过总结我院15年来937例(1226次)血液透析患者自体动静脉内瘘术的临床资料，探讨影响动静脉内瘘术成功的因素，同时评估在不同时期手术方式、手术部位对动静脉内瘘术的影响。
 方法：回顾性地对1994年1月-2008年10月我院住院行自体动静脉内瘘手术的937例患者的临床资料及辅助检查资料进行调查。每个患者的性别、年龄、原发病、透析时间等一般情况及手术时间、部位、方式、24小时内瘘通畅率、术后并发症等手术情况及辅助检查结果。计算手术的成功率，探讨不同阶段患者年龄、原发病、血压、血糖、血脂、血红蛋白、心功能状况及血管因素、血栓形成对内瘘成功的影响，比较自体内瘘在不同时期不同部位、不同方式对手术成功率的影响。
 结果：1、自2005年1月-2009年10月第一、第二、第三阶段的手术成功率分别为93%、91%、90%，总成功率为90.29%，无统计学差异(P>0.05)。2、三个阶段鼻咽壶部、前臂动静脉内瘘术临床效果无显著差异(P>0.05)。3、血管端侧吻合术建立动静脉内瘘优于端端及侧侧吻合术,差异具有显著性(P<0.05)。。
 结论：1、自体动静脉内瘘是维持血液透析的主要血管通路，导致内瘘失败的主要原因是血栓形成，老年、糖尿病、低血压、高脂血症是易患因素术前控制血糖、血脂，术中提高操作技能，术后给予适当的抗凝、防止低血压可以提高内瘘成功率。2、鼻咽壶部、前臂动静脉内瘘术临床效果无显著差异，对血管条件好的患者，鼻咽壶部位是首选。3、端侧吻合术建立动静脉内瘘是首选手术方式。

关键词：动静脉内瘘术；血液透析；血栓形成

论文类型：应用研究

 Title: Intravenous catheter application and management
ABSTRACT
 Objectives:With the extension of patients with dialysis age, population aging and diabetes, hypertension, peripheral vascular disease, the incidence increased year by year, autogenous arteriovenous fistula of the establishment of more difficult, its complications have in part withinconsistent with long-term dialysis fistula failure is the main problem facing patients.This article summarizes the hospital for 15 years to 937 cases (1226 times) hemodialysis patients with autogenous arteriovenous fistula of the clinical data to study the impact of arteriovenous fistula success factors, and assess the different periods of surgical procedure, surgical site of the arteriovenousthe impact of fistula surgery.
 Methods:A retrospective on the Jan 2005 - Oct 2009 our hospital in October autogenous arteriovenous fistula in 937 cases of clinical data and laboratory examinations data for investigation.Each patient's sex, age, primary disease, dialysis time and operation time of the general situation, location, manner, 24 hours, fistula patency, surgical conditions and postoperative complications secondary examination results.Calculate the success rate of surgery to explore the different stages of age, primary disease, blood pressure, blood sugar, blood lipids, hemoglobin, cardiac function and vascular factors, thrombosis success of internal fistula to compare the body fistula from different parts in different periods, differentapproach to surgical success rate    Results:1, from January 1994 -2 008 years, in October the first, second and third phase of the operation success rate was 93%, 91%, 90% and the total success rate was 90.29%, no significant difference (P> 0.05).2, three stages of nasopharyngeal pot forearm arteriovenous fistula was no significant difference in clinical effect (P> 0.05).3, the establishment of vascular anastomosis end to side arteriovenous fistula and superior to reason and side to side anastomosis, the difference was significant (P <0.05).    Conclusion:1, since the arteriovenous fistula is the main hemodialysis vascular access, leading to fistula failure is mainly due to thrombosis, the elderly, diabetes, low blood pressure, hyperlipidemia, preoperative risk factors is the control of blood glucose, blood lipids, surgery to improve operating skills, after appropriate anticoagulant, to prevent low blood pressure can increase the success rate of fistula.2, nasopharyngeal pot forearm arteriovenous fistula was no significant difference in clinical effect, patients with vascular conditions are good, nasopharyngeal pot is the preferred site.3, the establishment of end to side anastomosis arteriovenous fistula is the preferred surgical procedure.
 
Keywords:  arteriovenous fistula; hemodialysis; thrombosis; care
 
Type of thesis: Application research
 

 目  录
摘 要 IV
ABSTRACT V
1 绪论 1
1.1背景及意义 1
1.2研究目的及目标 1
1.3关键词及定义 2
1.4文献回顾 2
2 研究设计 4
2.1研究类型 4
2.2研究对象 4
2.3研究方法 4
2.4研究步骤 4
2.5统计方法 4
3.结果 6
3.1基本手术情况 6
3.2三个阶段动静脉内瘘失败原因统计与分析 6
3.3不同时期动静脉内瘘失败病例原因分析 6
4.讨论 8
4.1动静脉内瘘的适用范围 8
4.2手术失败原因分析 8
4.3护理措施 8
5.推论与建议 10
5.1结论 10
5.2本文的局限和展望 10
参考文献 11