延长自体动静脉内瘘使用寿命的最佳证据总结

doi:10.3761/j.issn.0254-1769.2022.21.007

摘要/Abstract

摘要：

目的检索、评价和总结延长自体动静脉内瘘使用寿命的最佳证据，旨在为医护人员规范管理自体动静脉内瘘提供依据。方法系统检索国内外数据库中关于延长自体动静脉内瘘使用寿命的相关文献，检索时限为建库至2021年6月1日，文献类型为临床决策、指南、证据总结、系统评价、Meta分析、专家共识，并提取相关证据。采用2017版临床指南研究与评价系统Ⅱ（the appraisal of guidelines for research and evaluation Ⅱ，AGREE Ⅱ）、澳大利亚乔安娜布里格斯研究所循证卫生保健中心的文献质量评价标准、证据分级系统以及系统评价方法学质量评价工具（a measure tool to assess systematic reviews，AMSTAR 2），对各类研究进行质量评价及证据级别的评定。结果共纳入14篇文献，包括临床决策2篇、指南4篇、系统评价7篇、专家共识1篇，总结了血管保护、围手术期管理、穿刺以及监测4个方面的证据。结论该研究总结了延长自体动静脉内瘘使用寿命的最佳证据，为临床提高自体动静脉内瘘维护水平，延长其使用寿命提供依据。

关键词: 血液透析, 自体动静脉内瘘, 证据总结, 循征护理学

Abstract:

Objective To search，evaluate and summarize the best evidence of prolonging the life length of arteriovenous fistula（AVF），in order to provide a basis for medical staff to standardize the management of AVF. Methods The relevant evidence of prolonging the life length of AVF was systematically searched from domestic and foreign databases.The retrieval time is from the database construction to June 1，2021. Clinical decision-making，guidelines，evidence summaries，systematic evaluation，meta-analysis and expert consensuses are included. AGREE Ⅱ，the Document Quality Evaluation Criteria and Evidence Recommendation Level System（2014 edition） of JBI and AMSTAR 2 are used to evaluate the quality and evidence recommendation level of various studies. Results A total of 14 pieces of the literature were included in this study，including 2 clinical decisions，4 guidelines，1 expert consensus and 7 systematic reviews. 4 aspects of the evidence were summarized，including vascular protection，perioperative management，puncture and monitoring. Conclusion This study summarizes the best evidence for prolonging the life length of AVF，and provides a basis for improving the nursing and protecting level of AVF and prolonging its lifetime.

Key words: Hemodialysis, Arteriovenous Fistula, Summary of Evidence, Evidence-Based Nursing

杜爱燕, 汪亚文, 赵从敏, 张渊, 周薇, 史晓芬, 蔡英华. 延长自体动静脉内瘘使用寿命的最佳证据总结[J]. 中华护理杂志, 2022, 57(21): 2604-2610.

DU Aiyan, WANG Yawen, ZHAO Congmin, ZHANG Yuan, ZHOU Wei, SHI Xiaofen, CAI Yinghua. Summary of the best evidence for prolonging the lifetime of autologous arteriovenous fistula[J]. Chinese Journal of Nursing, 2022, 57(21): 2604-2610.

图/表 5

图1 文献检索流程

Figurel 1 Flowchart of literature screening

表1 纳入文献的基本特征（n=14）

Table 1 Basic characteristics of the included literature（n=14）

表2 指南质量评价结果（n=4）

Table 2 Quality evaluation results of guidelines（n=4）

表3 系统评价的质量评价结果（n=7）

Table 3 Quality evaluation results of the systematic review（n=7）

表4 延长自体动静脉内瘘使用寿命的最佳证据

Table 4 The best evidence for prolonging the life length of arteriovenous fistula

参考文献 34

[1]	赵新菊, 甘良英, 牛庆雨, 等. 中国血液透析患者死亡原因及特点分析-DOPPS研究的启示[J]. 中国血液净化, 2022, 21(2):89-93.
	Zhao XJ, Gan LY, Niu QY, et al. The cause of death and its related information in hemodialysis patients in China-enlightenment from the DOPPS study[J]. Chin J Blood Purif, 2022, 21(2):89-93.
[2]	王晗, 倪其泓, 王预立, 等. 自体动静脉内瘘成熟影响因素及机制研究进展[J]. 中华普通外科杂志, 2021, 36(1):71-74.
	Wang H, Ni QH, Wang YL, et al. Research progress on influencing factors and mechanism of maturation of autogenous arteriovenous fistula[J]. Chin J Surgery, 2021, 36(1):71-74.
[3]	Lok CE, Huber TS, Lee T, et al. KDOQI clinical practice guideline for vascular access:2019 update[J]. Am J Kidney Dis, 2020, 75(4 Suppl 2):S1-S164.
[4]	金其庄, 王玉柱, 叶朝阳, 等. 中国血液透析用血管通路专家共识(第2版)[J]. 中国血液净化, 2019, 18(6):365-381.
	Jin QZ, Wang YZ, Ye CY, et al. Consensus among experts on blood access used for hemodialyis in China(The 2nd edition)[J]. Chin J Blood Purif, 2019, 18(6):365-381.
[5]	周乐天, 刘虹, 刘伏友, 等. 472例自体动静脉内瘘的生存分析和影响因素[J]. 中南大学学报(医学版), 2015, 40(8):902-906.
	Zhou LT, Liu H, Liu FY, et al. Survival analysis and risk factors for arteriovenous fistula in 472 patients[J]. J Central South Univ Med Sci, 2015, 40(8):902-906.
[6]	赵旭, 王伟, 赵小静, 等. 慢性心力衰竭患者出入量管理的最佳证据总结[J]. 中华护理杂志, 2020, 55(3):456-461. DOI
	Zhao X, Wang W, Zhao XJ, et al. Best evidence summary for management of output and input in chronic heart failure patients[J]. Chin J Nurs, 2020, 55(3):456-461. DOI
[7]	周芬, 郝玉芳, 丛雪, 等. 指南研究与评价工具AGREE Ⅱ及各领域分值的补充解释及思考[J]. 护理学报, 2018, 25(18):56-58.
	Zhou F, Hao YF, Cong X, et al. Guidelines for research and evaluation tool AGREE Ⅱ and supplementary interpretation and thinking of scores in various fields[J]. J Nurs China, 2018, 25(18):56-58.
[8]	胡雁, 郝玉芳. 循证护理学[M]. 2版. 北京: 人民卫生出版社, 2017:31.
	Hu Y, Hao YF. Evidence-based nursing[M]. 2nd ed. Beijing: People’s Publishing House, 2017:31.
[9]	张方圆, 沈傲梅, 曾宪涛, 等. 系统评价方法学质量评价工具AMSTAR 2解读[J]. 中国循证心血管医学杂志, 2018, 10(1):14-18.
	Zhang FY, Shen AM, Zeng XT, et al. An introduction to AMSTAR 2:a critical appraisal tool for systematic reviews[J]. Chin J Evid Based Cardiovasc Med, 2018, 10(1):14-18.
[10]	徐霓影, 任昕燕, 王茜茜, 等. 痴呆患者进食困难管理的最佳证据总结[J]. 中华护理杂志, 2021, 56(9):1401-1407. DOI
	Xu NY, Ren XY, Wang XX, et al. Evidence summary of management of feeding difficulty in people with dementia[J]. Chin J Nurs, 2021, 56(9):1401-1407. DOI
[11]	徐蓉, 汪晖, 杨伟梅, 等. 患者身份识别最佳证据总结[J]. 中华护理杂志, 2021, 56(6):921-928. DOI
	Xu R, Wang H, Yang WM, et al. Evidence summary of patient identification[J]. Chin J Nurs, 2021, 56(6):921-928. DOI
[12]	王春青, 胡雁. JBI证据预分级及证据推荐级别系统(2014版)[J]. 护士进修杂志, 2015, 30(11):964-967.
	Wang CQ, Hu Y. JBI evidence pre-classification and evidence rank system(2014 Edition)[J]. J Nurses Train, 2015, 30(11):964-967.
[13]	Beathard GA. Primary failure of the hemodialysis arteriovenous fistula-UpToDate[EB/OL].(2021-01-13)[2021-06-01]. https://www.uptodate.cn/contents/primary-failure-of-the-hemodialysis-arteriovenous-fistula?search=arteriovenous%20fistula&source=search_result&selectedTitle=5-150&usage_type=default&display_rank=5.
[14]	Beathard GA. Failure of the mature hemodialysis arteriovenous fistula UpToDate[EB/OL].(2021-01-20)[2021-06-01]. https://www.uptodate.cn/contents/failure-of-the-mature-hemodialysis-arteriovenous-fistulasearch=arteriovenous%20fistula&source=search_result&selectedTitle=6-150&usage_type=default&display_rank=6.
[15]	Kumwenda M, Mitra S, Reid C. Clinical practice guideline vascular access for haemdialysis[EB/OL]. (2015-03-31)[2021-06-01]. https://www.renal.org/guidelines.
[16]	Fluck R, Kumwenda M. Renal association clinical practice guideline on vascular access for haemodialysis[J]. Nephron Clin Pract, 2011, 118(Suppl 1):c225-c240.
[17]	Kukita K, Ohira S, Amano I, et al. 2011 update Japanese society for dialysis therapy guidelines of vascular access construction and repair for chronic hemodialysis[J]. Ther Apher Dial, 2015, 19(Suppl 1):1-39.
[18]	王慧, 孙秀丽, 吴红梅, 等. 新建立自体动静脉内瘘首次穿刺时间对内瘘预后影响的系统评价和Meta分析[J]. 中国血液净化, 2018, 17(2):107-113.
	Wang H, Sun XL, Wu HM, et al. Influence of the first cannulation time for newly established arteriovenous fistula on vascular access failure:a systematic review and meta-analysis[J]. Chin J Blood Purif, 2018, 17(2):107-113.
[19]	郑雯雯, 鲁春红, 戴小梅, 等. 维持性血液透析患者自体动静脉内瘘失功危险因素的Meta分析[J]. 中国血液净化, 2019, 18(10):705-709.
	Zheng WW, Lu CH, Dai XM, et al. Risk factors for autologous arteriovenous fistula dysfunction in hemodialysis patients:a meta analysis[J]. Chin J Blood Purif, 2019, 18(10):705-709.
[20]	王培莉, 施素华, 林巧红, 等. 扣眼穿刺法与绳梯穿刺法对动静脉内瘘功能影响的Meta分析[J]. 中国血液净化, 2020, 19(1):65-69.
	Wang PL, Shi SH, Lin QH, et al. The effects of buttonhole versus rope-ladder cannulation on the function of arteriovenous fistulas:a meta-analysis[J]. Chin J Blood Purif, 2020, 19(1):65-69.
[21]	Georgiadis GS, Charalampidis DG, Argyriou C, et al. The necessity for routine pre-operative ultrasound mapping before arteriovenous fistula creation:a meta-analysis[J]. Eur J Vasc Endovasc Surg, 2015, 49(5):600-605. DOI URL
[22]	Wan QS, Yang SK, Li L, et al. Effects of far infrared therapy on arteriovenous fistulas in hemodialysis patients:a meta-analysis[J]. Ren Fail, 2017, 39(1):613-622. DOI URL
[23]	Bashar K, Healy D, Browne LD, et al. Role of far infra-red therapy in dialysis arterio-venous fistula maturation and survival:systematic review and meta-analysis[J]. PLoS One, 2014, 9(8):e104931. DOI URL
[24]	魏宇, 宋雅丽, 袁丽莎, 等. 活血化瘀中药外用对动静脉内瘘功能影响的系统评价[J]. 上海护理, 2020, 20(11):15-21.
	Wei Y, Song YL, Yuan LS, et al. A systematic review on the effect of traditional Chinese medicine for activating blood circulation and removing blood stasis for external use on the function of internal arteriovenous fistula[J]. Shanghai Nurs, 2020, 20(11):15-21.
[25]	Ters ME, Schears GJ, Taler SJ, et al. Association between prior peripherally inserted central catheters and lack of functioning arteriovenous fistulas:a case-control study in hemodialysis patients[J]. Am J Kidney Dis, 2012, 60(4):601-608. DOI URL
[26]	Gonsalves CF, Eschelman DJ, Sullivan KL, et al. Incidence of central vein stenosis and occlusion following upper extremity PICC and port placement[J]. Cardiovasc Intervent Radiol, 2003, 26(2):123-127. DOI URL
[27]	Yaghoubian A, Lewis RJ, de Virgilio C. Can the National Kidney Foundation guidelines for first-time arteriovenous fistula creation be met in underserved end-stage renal disease patients?[J]. Ann Vasc Surg, 2008, 22(1):5-10. PMID
[28]	吕忠美, 朱亚梅, 顾艳红, 等. 动静脉内瘘围手术期患者功能锻炼开始时间的研究[J]. 中华护理杂志, 2019, 54(8):1224-1228. DOI
	Lü ZM, Zhu YM, Gu YH, et al. Research on the starting time of perioperative functional exercise in patients with arteriovenous fistula[J]. Chin J Nurs, 2019, 54(8):1224-1228. DOI
[29]	MacRae JM, Ahmed SB, Hemmelgarn BR, et al. Arteriovenous fistula survival and needling technique:long-term results from a randomized buttonhole trial[J]. Am J Kidney Dis, 2014, 63(4):636-642. DOI URL
[30]	Chow J, Rayment G, Miguel SS, et al. A randomised controlled trial of buttonhole cannulation for the prevention of fistula access complications[J]. J Ren Care, 2011, 37(2):85-93. DOI URL
[31]	Elsharawy MA, Moghazy KM. Pre-operative evaluation of hemodialysis access fistula. A multidisciplinary approach[J]. Acta Chir Belg, 2005, 105(4):355-358. PMID
[32]	Lok CE, Foley R. Vascular access morbidity and mortality:trends of the last decade[J]. Clin J Am Soc Nephrol, 2013, 8(7):1213-1219. DOI URL
[33]	Mbamalu G, Whiteman K. Vascular access team collaboration to decrease catheter rates in patients on hemodialysis:utilization of Kotter’s change process[J]. Nephrol Nurs J, 2014, 41(3):283-287x#&quiz288.
[34]	Gill S, Quinn R, Oliver M, et al. Multi-disciplinary vascular access care and access outcomes in people starting hemodialysis therapy[J]. Clin J Am Soc Nephrol, 2017, 12(12):1991-1999. DOI URL