Objective To evaluate the effect of Fogarty balloon catheter embolectomy on arteriovenous graft thrombosis in hemodialysis patients. Methods We retrospectively analyzed the clinical data of 11 patients who underwent maintaining hemodialysis and arteriovenous graft thrombosis through Fogarty balloon catheter embolectomy between March 2010 and November 2014. The thrombosed graft was incised, and a 4 or 6 French catheter was placed in the venous and arterial limbs of the graft respectively. The Fogarty balloon was passed beyond the thrombus and pulled out after saline was infused into the balloon, and the thrombus was taken out. The procedure was considered unsuccessful if the blood flow was not re-established or if the graft re-thrombosed within hours. Results The treatment was successfully performed in all the patients. Of the 11 patients, 3 received balloon dilation due to stenosis of venous anastomosis, and 2 received angioplasty due to underlying arterial anastomosis lesion. After corresponding measures were taken, the thrombus of all the 11 patients were taken out, and blood flow was recovered. Two to seven days after surgery, low molecular weight heparin was used for anti-coagulation. The blood flow of all arteriovenous grafts reached over 250 mL/min. All the patients were followed up for 4 to 30 months. During the follow-up, the arteriovenous graft remained functional in 5 patients; 4 patients had re-thrombosis on day 2, 3, 25, and 71 after surgery respectively; one changed to undergo peritoneal dialysis due to rupture and infection of the graft, and one patient was transferred to another hospital in another area and was not followed up any longer. The therapy was successful in 81.8% of this group of patients. Conclusion Fogarty balloon catheter embolectomy is effective in restoring patency of thrombosed arteriovenous graft in hemodialysis patients, and more studies are needed.
At present, the whole lifecycle management of vascular access for hemodialysis in China is still in its early stages. Faced with a large group of chronic kidney disease patients, hospitals at all levels lack systematic and continuous nursing management models. To address the issue of lacking continuous and effective nursing management of vascular access for dialysis during the period from hospitalization for autologous arteriovenous fistula surgery to outpatient maintenance hemodialysis treatment, this article introduces the background, specific implementation methods, and preliminary results of the new model of integrated medical and nursing follow-up management of vascular access for patients with hemodialysis during hospitalization and outpatient period constructed by the Wenjiang Hemodialysis Center of West China Hospital, Sichuan University. The purpose is to explore a new model for continuous and effective management of vascular access for hemodialysis patients.
目的 研究自体动静脉内瘘全程规范化护理的可实施性及优势。 方法 制定自体动静脉内瘘全程规范化护理工作流程及标准，将2011年6月－8月经自体动静脉内瘘行维持性血液透析患者随机分为观察组（125例）和对照组（115例），分别予以全程规范化护理和普通护理，对比分析两组之间内瘘不良事件发生率、患者满意度、护士认同度等指标的差异。 结果 两组内瘘不良事件发生率分别为8.0%和21.0%，患者满意度分别为98.4%和84.3%，差异均有统计学意义（P＜0.05）；两组护士对本组护理模式认同度均为90.0%，差异无统计学意义（P＞0.05）。 结论 自体动静脉内瘘全程规范化护理模式能有效降低内瘘不良事件发生率并显著提高患者满意度，值得临床推广。
Venous pressure monitoring is an important indicator for the arteriovenous fistula evaluation. Direct static venous pressure monitoring is recognized as the most accurate way of venous pressure monitoring, which is widely used in the functional monitoring, functional evaluation of arteriovenous fistula, the diagnosis of complications and the evaluation of surgical efficacy. Venous pressure monitoring has obvious advantages and disadvantages, so it is necessary to improve relevant knowledge to correctly guide clinical diagnosis and treatment. In this paper, the study of static venous pressure monitoring of arteriovenous fistula was summarized, in order to improve the understanding of the significance and clinical application of static venous pressure monitoring of arteriovenous fistula.
目的探讨胆囊结石病引起胆道内瘘的原因，提高其诊断和治疗水平。方法收集我院1990～1999年收治的胆道内瘘患者46例，并对其病因、诊断与治疗进行分析。结果胆囊十二指肠瘘18例（39.1%），胆囊结肠瘘8例（17.4%），胆囊与胃、空肠内瘘各1例（4.3%）； 胆囊胆管瘘18例（39.1%）。术后出现并发症4例（8.7%），死亡1例（2.2%），治愈率为97.8%。结论重视本病的临床表现及术前、术中检查，选择恰当手术方式，可减少死亡与并发症的发生。