肾内科医生和血管外科医生建立的用于血液透析的动静脉瘘有区别吗？

Are There Differences in Arteriovenous Fistulae Created for Hemodialysis between Nephrologists and Vascular Surgeons?

机构信息

Department of Internal Medicine, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia,

Institute of Medical Statistics and Informatics, Faculty of Medicine University of Belgrade, Belgrade, Serbia.

出版信息

Med Princ Pract. 2021;30(2):178-184. doi: 10.1159/000512632. Epub 2020 Oct 29.

DOI:10.1159/000512632

PMID:33120382

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8114068/

Abstract

OBJECTIVE

Many studies have reported insufficient support from surgical services, resulting in nephrologists creating arteriovenous fistulas in many centers. The aim of this study was to compare risk factors of arteriovenous fistula dysfunction in patients whose fistulas were created by nephrologists versus vascular surgeons.

METHODS

This was a retrospective, analytical study of interventions by nephrologists and vascular surgeons during a period of 15 years. Out of a total of 1,048 fistulas, 764 (72.9%) were created by nephrologists patients, while vascular surgeons were responsible for 284 (27.1%) fistulae. Laboratory, demographic, and clinical parameters which might affect functioning of these arteriovenous fistulae were analyzed.

RESULTS

Patients whose arteriovenous fistula was formed by nephrologists differed significantly from those created by vascular surgeons in relation to the preventive character of the arteriovenous fistula (p = 0.011), lumen of the vein (p < 0.001) and systolic blood pressure (p = 0.047). Multivariate logistic regression of arteriovenous fistula dysfunction showed that risk factors were female gender (odds ratio [OR] = 1.56, 95% CI 1.16-2.07), whether the fistulae were created by vascular surgeons or nephrologists (OR = 1.38; 95% CI 1.01-1.89) and the site of the arteriovenous fistula (OR = 0.64; 95% CI 0.48-0.85).

CONCLUSIONS

Arteriovenous fistulae created by vascular surgeons, female gender, and the location are risk factors of dysfunction.

摘要

目的

许多研究报告称外科服务支持不足，导致许多中心的肾病医生都在创建动静脉瘘。本研究旨在比较由肾病医生和血管外科医生创建的动静脉瘘功能障碍的危险因素。

方法

这是一项回顾性、分析性研究，对 15 年来肾病医生和血管外科医生的干预措施进行了研究。在总共 1048 个瘘管中，764 个（72.9%）由肾病医生患者创建，而血管外科医生则负责 284 个（27.1%）瘘管。分析了可能影响这些动静脉瘘功能的实验室、人口统计学和临床参数。

结果

与由血管外科医生创建的瘘管相比，由肾病医生创建的动静脉瘘在预防性（p = 0.011）、静脉管腔（p < 0.001）和收缩压（p = 0.047）方面存在显著差异。动静脉瘘功能障碍的多变量逻辑回归显示，危险因素为女性（优势比 [OR] = 1.56，95%可信区间 1.16-2.07）、瘘管是由血管外科医生还是肾病医生创建（OR = 1.38；95%可信区间 1.01-1.89）以及动静脉瘘的部位（OR = 0.64；95%可信区间 0.48-0.85）。