Mandel S R, Martin P L, Blumoff R L, Mattern W D
Arch Surg. 1977 Nov;112(11):1375-80. doi: 10.1001/archsurg.1977.01370110109012.
Vascular access has become the most common operation performed at North Carolina Memorial Hospital, Chapel Hill. Three hundred vascular access procedures performed between 1971 and 1975 were reviewed as to results, costs, and manpower commitment. Subcutaneous radial arterial venous fistula was the procedure of choice, with a 67% two-year patency and the lowest incidence of complications. An average of 1.7 operations per patient was necessary to maintain access. Patients used an average of 19 hospital days per year of dialysis for vascular access and an average of 35 hospital days per year of dialysis for all medical problems. Cost of hospitalization averaged $6,818 per patient per year of dialysis, and for vascular access alone averaged $3,452 per patient per year of dialysis. To create and maintain vascular access, 1,000 hours of operating room time were required, at an expense of $200,000. Vascular access in support of patients undergoing chronic hemodialysis requires a massive commitment of dollars, time, and personnel.
血管通路已成为北卡罗来纳大学教堂山分校纪念医院最常见的手术。回顾了1971年至1975年间进行的300例血管通路手术的结果、成本和人力投入情况。皮下桡动脉-静脉内瘘是首选术式，其两年通畅率为67%，并发症发生率最低。平均每位患者需要进行1.7次手术以维持血管通路。患者因血管通路问题每年平均住院透析19天，因所有医疗问题每年平均住院透析35天。每位患者每年透析的住院费用平均为6818美元，仅血管通路问题的住院费用平均为每位患者每年透析3452美元。建立和维持血管通路需要1000小时的手术室时间，费用为20万美元。为接受慢性血液透析的患者提供血管通路需要大量的资金、时间和人力投入。
