直接吻合留置针穿刺:肾功能衰竭患者快速、安全的过渡性血液透析途径。

IF 3 3区 医学 Q1 UROLOGY & NEPHROLOGY
Renal Failure Pub Date : 2025-12-01 Epub Date: 2025-01-19 DOI:10.1080/0886022X.2024.2448255
Chunyan Wu, Jianbo Qing, Xiaoping Wang, Yunmei Li, Xin Zhou, Junnan Wu
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引用次数: 0

摘要

目的:血管通路血栓形成(Vascular access thrombosis, VAT)是终末期肾病(ESRD)患者常见的并发症,严重影响血液透析疗效和患者生存。目前,临时透析通道通常通过深静脉导管(VC)建立,然而,这种方法具有高度侵入性,并且存在感染和其他并发症的风险。本研究旨在探讨直接吻合留置针穿刺(DAINP)用于临时透析通路的可行性。方法:于2023年3月至2024年3月在浙江大学医学院邵逸夫医院招募VAT患者接受DAINP治疗。收集临床资料,包括年龄、性别、干、湿体重、血液生化指标。记录了患者VA类型、位置和介入血管。对所有患者进行详细的VAT评估和记录,包括血栓与吻合口的距离、VA吻合口残余血流量以及相应的DAINP插入部位的选择。超声测量并记录穿刺深度。同时,收集静脉置管(VC)临时透析通路患者的临床资料。两组的手术时间,定义为从超声评估开始到手术完成的时间间隔,记录并比较。结果:74例患者成功行DAINP穿刺,穿刺成功率100%。其中20例VA残端有残余血流,吻合口与动脉血流距离≥1 cm。位于肘部的VA患者穿刺深度最大。此外,DAINP组的手术时间明显短于同期VC行VAT的17例患者。然而,位于腹股沟的VA患者需要更长的DAINP手术时间。结论:本研究表明,DAINP为VAT患者建立临时血液透析通路提供了一种快速、安全的方法,有效降低了传统VC相关的侵入性和风险。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Direct anastomosis indwelling needle puncture: a rapid and safe transitional hemodialysis access for patients with renal failure.

Objectives: Vascular access thrombosis (VAT) is a common complication in patients with end-stage renal disease (ESRD), significantly impacting hemodialysis efficacy and patient survival. Currently, temporary dialysis access is typically established via deep vein catheterization (VC), however, this method is highly invasive and associated with risks of infection and other complications. This study aims to explore the feasibility of using direct anastomosis indwelling needle puncture (DAINP) for temporary dialysis access.

Methods: Between March 2023 and March 2024, patients VAT were recruited at Sir Run Run Shaw Hospital of Zhejiang University School of Medicine to undergo DAINP. Clinical data, including age, gender, dry and wet body weight, and blood biochemical parameters, were collected. Patient VA types, locations, and insertion vessels were documented. Detailed assessments and records of VAT were performed for all patients, including the distance of thrombus from the anastomosis, residual blood flow at the VA anastomosis, and corresponding selection of the DAINP insertion site. Ultrasound was utilized to measure and record the puncture depth. Concurrently, clinical data of patients undergoing venous catheterization (VC) for temporary dialysis access were collected. The operative time for both groups, defined as the interval from ultrasound assessment initiation to completion of the procedure, was recorded and compared.

Results: A total of 74 patients successfully underwent DAINP, with a 100% puncture success rate. Among them, 20 patients had residual blood flow at the VA stump, and the distance between the anastomosis and arterial flow was ≥ 1 cm. Patients with VA located at the elbow demonstrated the greatest puncture depth. Moreover, the operative time for the DAINP group was significantly shorter compared to the 17 patients who underwent VC for VAT during the same period. However, patients with VA located in the groin required a longer operative time for DAINP.

Conclusions: This study demonstrates that DAINP provides a rapid and safe method for establishing temporary hemodialysis access in VAT patients, effectively reducing the invasiveness and risks associated with traditional VC.

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来源期刊
Renal Failure
Renal Failure 医学-泌尿学与肾脏学
CiteScore
3.90
自引率
13.30%
发文量
374
审稿时长
1 months
期刊介绍: Renal Failure primarily concentrates on acute renal injury and its consequence, but also addresses advances in the fields of chronic renal failure, hypertension, and renal transplantation. Bringing together both clinical and experimental aspects of renal failure, this publication presents timely, practical information on pathology and pathophysiology of acute renal failure; nephrotoxicity of drugs and other substances; prevention, treatment, and therapy of renal failure; renal failure in association with transplantation, hypertension, and diabetes mellitus.
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