不同入路对动静脉瘘的影响：RCT研究
作者：Emma Vaux, Jennie King, Swee Lloyd, Jane Moore, et al. 来源：AJKD 日期：2013-03-12
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动静脉瘘
Effect of Buttonhole Cannulation With a Polycarbonate Peg on In-Center Hemodialysis Fistula Outcomes: A Randomized Controlled Trial
Background
Quality improvement strategies to increase and maintain the numbers of arteriovenous fistulas (AVFs) are a critical drive in enhancing the quality of care of patients receiving treatment with hemodialysis. How the AVF is needled is an important consideration in AVF survival; the ideal cannulation technique has not been established to date.
Study Design
Prospective randomized single-center trial.
Setting & Participants
Patients on maintenance hemodialysis therapy (N = 140).
Intervention
A 1-year intervention of buttonhole (constant site) or usual-practice (different site) cannulation.
Outcomes
Primary study outcome was AVF survival over 1 year, in which AVF failure was defined as an AVF no longer used for hemodialysis (also referred to as assisted patency). Secondary outcomes included primary patency, number of access interventions, bleeding time, infection rate, cannulation time and pain, and aneurysm formation.
Results
Demographic data were similar for both groups. The primary outcome measure of AVF survival at 1 year was statistically significantly increased in the buttonhole group (100% vs 86% with usual practice; P = 0.005, log-rank test). In the buttonhole group, there were fewer interventions (19% vs 39% in usual practice) and less existing aneurysm enlargement (23% vs 67% in usual practice). There were no bacteremia events in the buttonhole group and 2 in the usual-practice group (0.09/1,000 AVF days). There were no significant differences in bleeding times and lignocaine use between the 2 groups.
Limitations
A single-center study, lack of blinding.
Conclusions
In this study, AVF survival was significantly greater when using buttonhole cannulation. The buttonhole technique significantly decreased the need for access interventions and reduced existing aneurysm enlargement. Concerns of increased infection rates or prolonged bleeding times with the buttonhole technique were not seen in this study. The buttonhole technique should be considered the cannulation technique of choice for AVFs.
http://www.ajkd.org/article/S0272-6386(13)00101-7/abstract
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