بررسي زمان قابل استفاده شدن فيستو لهاي شرياني وريدي تعبيه شده براي بيماران با بيماري مزمن كليه و ارتباط آن با بيمار يهاي زمين هاي

Survey of Maturation Time of Arteriovenous Fistula for Patients with Renal Disease and its Relationship with Underlying Diseases

ﺯﻣﻴﻨﻪ ﻭ ﻫﺪﻑ: ﺩﺳﺘـﺮﺳﻲ ﻋﺮﻭﻗﻲ ﺟﻬﺖ ﺍﻧﺠﺎﻡ ﻫﻤـﻮﺩﻳﺎﻟﻴﺰ ﺑﺮﺍﻱ ﺑﻴﻤﺎﺭﺍﻥ ﺩﭼـﺎﺭ ﺑﻴﻤﺎﺭﻱ ﻛﻠﻴـﻮﻱ ﻛﺎﻣﻼ "ﺣﻴﺎﺗﻲ ﺍﺳﺖ. ﻣﻌﻤﻮﻻﹰ ﺑﻴﻤﺎﺭﺍﻧﻲ ﮐﻪ ﺗﺤﺖ ﻫﻤﻮﺩﻳﺎﻟﻴﺰ ﻗﺮﺍﺭ ﻣﻲ ﮔﻴﺮﻧﺪ، ﺑﺎﻳﺪ ﺑﺮﺍﻱ ﻗﺮﺍﺭ ﺩﺍﺩﻥ ﻓﻴﺴﺘﻮﻝ ﻫﺎﻱ ﺷﺮﻳﺎﻧﻲ ﻭﺭﻳﺪﻱ ﺗﺤﺖ ﻋﻤﻞ ﻗﺮﺍﺭ ﮔﻴﺮﻧﺪ. ﺩﺭ ﺍﻳﻦ ﻣﻄﺎﻟﻌﻪ ﺯﻣﺎﻥ ﻗﺎﺑﻞ ﺍﺳﺘﻔﺎﺩﻩ ﺷﺪﻥ ﻓﻴﺴﺘﻮﻝ ﻫﺎﻱ ﺷﺮﻳﺎﻧﻲ ﻭﺭﻳﺪﻱ ﺗﻌﺒﻴﻪ ﺷـﺪﻩ ﺑﺮﺍﻱ ﺑﻴﻤـﺎﺭﺍﻥ ﺑﺎ ﺑﻴﻤﺎﺭﻱ ﻣـﺰﻣﻦ ﮐﻠﻴـﻪ ﻭ ﺍﺭﺗﺒﺎﻁ ﺁﻥ ﺑﺎ ﺑﻴﻤـﺎﺭﻱ ﻫﺎﻱ ﺯﻣﻴﻨﻪ ﺍﻱ ﻣـﻮﺭﺩ ﺑﺮﺭﺳﻲ ﻗـﺮﺍﺭ ﮔﺮﻓﺘﻪ ﺍﺳﺖ. ﻣﻮﺍﺩ ﻭ ﺭﻭﺵ ﻫﺎ: ﺩﺭ ﺍﻳﻦ ﻣﻄـﺎﻟﻌﻪ ﺑﻪ ﺭﻭﺵ ﻣﻘﻄـﻌﻲ ﺑﺎ ﺭﻭﻳﻜـﺮﺩ ﺁﻳﻨﺪﻩ ﻧﮕـﺮ 87 ﺑﻴﻤـﺎﺭ ﻛﻪ ﺗﺤـﺖ ﻋﻤﻞ ﺟـﺮﺍﺣﻲ ﺗﻌﺒﻴﻪ ﻓﻴﺴﺘـﻮﻝ ﺷﺮﻳﺎﻧﻲ ـ ﻭﺭﻳﺪﻱ ﻗﺮﺍﺭ ﮔﺮﻓﺘﻪ ﺑﻮﺩﻧﺪ، ﺑﺮﺭﺳﻲ ﺷﺪﻧﺪ. ﻣﺤﻞ ﻓﻴﺴﺘﻮﻝ ﺩﺭ ﺗﻤﺎﻡ ﺑﻴﻤﺎﺭﺍﻥ ﺣﻔﺮﻩ ﺁﺭﻧﺠﯽ )(Antecubital ﺑﺎ ﺍﺳﺘﻔﺎﺩﻩ ﺍﺯ ﭘﺮﻭﮔﺰﻳﻤﺎﻝ ﺷﺮﻳﺎﻥ ﺭﺍﺩﻳﺎﻝ ﺑﻮﺩ ﻭ ﻓﺎﺻﻠﻪ ﺟﺮﺍﺣﻲ ﺗﺎ ﺯﻣﺎﻥ ﺷﺮﻭﻉ ﺍﻭﻟﻴﻦ ﺩﻳﺎﻟﻴﺰ ﺑﻪ ﻋﻨﻮﺍﻥ ﺯﻣﺎﻥ ﻗﺎﺑﻞ ﺍﺳﺘﻔﺎﺩﻩ ﺷﺪﻥ ﻓﻴﺴﺘﻮﻝ )Maturation Time( ﺩﺭ ﻧﻈﺮ ﮔﺮﻓﺘﻪ ﺷﺪﻩ ﻭ ﺭﺍﺑﻄﻪ ﺁﻥ ﺑﺎ ﻋﻮﺍﻣﻞ ﺧﻄﺮﺯﺍ ﺑﺮﺍﻱ ﺁﺗﺮﻭﺍﺳﻜﻠﺮﻭﺯ، ﺩﻳﺎﺑﺖ، ﻫﻴﭙﺮﺗﺎﻧﺴﻴﻮﻥ، ﺩﻳﺲ ﻟﻴﭙﻴﺪﻣﻲ، ﺳﺎﺑﻘﻪ ﺑﻴﻤﺎﺭﻱ ﻫﺎﻱ ﻗﻠﺒﻲ ﻋﺮﻭﻗﻲ ﻭ ﻋﻠﺖ ﻧﺎﺭﺳﺎﻳﻲ ﺑﻴﻤﺎﺭﻱ ﻛﻠﻴﻮﻱ ﺑﺮﺭﺳﻲ ﺷﺪ. ﻳﺎﻓﺘﻪ ﻫﺎ: 26 ﺑﻴﻤﺎﺭ )29/9 ﻣﺆﻧﺚ ﻭ 61 ﺑﻴﻤﺎﺭ ﻣﺬﻛﺮ )70/1 ﻭﺍﺭﺩ ﻣﻄﺎﻟﻌﻪ ﺷﺪﻧﺪ. ﻣﻴﺎﻧﮕﻴﻦ ﺯﻣﺎﻥ ﻗﺎﺑﻞ ﺍﺳﺘﻔﺎﺩﻩ ﺷﺪﻥ ﻓﻴﺴﺘﻮﻝ ﺩﺭ ﺑﻴﻤﺎﺭﺍﻥ ﺗﺤﺖ ﻣﻄﺎﻟﻌﻪ 5/6±2/4 ﻫﻔﺘﻪ ﺑﻮﺩ. ﺯﻣﺎﻥ ﻗﺎﺑﻞ ﺍﺳﺘﻔﺎﺩﻩ ﺷﺪﻥ ﻓﻴﺴﺘﻮﻝ ﺩﺭ ﺑﻴﻤﺎﺭﺍﻥ ﺩﻳﺎﺑﺘﻲ ﻭ ﻏﻴﺮ ﺩﻳﺎﺑﺘﻲ ﺑﻪ ﺗﺮﺗﻴﺐ 6/1±2/4 ﻭ 4/9±2/2 ﻫﻔﺘﻪ )P=0.016(، ﺩﺭ ﺑﻴﻤﺎﺭﺍﻥ ﺩﺍﺭﺍﻱ ﻭ ﻓﺎﻗﺪ ﺳﺎﺑﻘﻪ ﺑﻴﻤﺎﺭﻱ ﻗﻠﺒﻲ ﺑﻪ ﺗﺮﺗﻴﺐ 6/8±2/5 ﻭ 5/1±2/1 ﻫﻔﺘﻪ P=0.001)(، ﺩﺭ ﺑﻴﻤﺎﺭﺍﻥ ﺩﺍﺭﺍﻱ ﻓﺸﺎﺭ ﺧﻮﻥ ﻣﺘﻮﺳﻂ ﺷﺮﻳﺎﻧﻲ ﻛﻤﺘﺮ ﺍﺯ 110 ﻭ ﻣﺴﺎﻭﻱ 110 ﻭ ﺑﻴﺸﺘﺮ ﺑﻪ ﺗﺮﺗﻴﺐ ﻣﻴﻠﻲ ﻣﺘﺮ ﺟﻴﻮﻩ 6/1±2/4 ﻭ 3/6±0/8 ﻫﻔﺘﻪ P=0.001)( ﺑﻮﺩ. ﺿﺮﻳﺐ ﻫﻤﺒﺴﺘﮕﻲ ﻣﻴﺎﻥ ﺳﻦ ﺑﻴﻤﺎﺭﺍﻥ ﺑﺎ ﺯﻣﺎﻥ ﻗﺎﺑﻞ ﺍﺳﺘﻔﺎﺩﻩ ﺷﺪﻥ ﻓﻴﺴﺘﻮﻝ 0/453 ﻣﺤﺎﺳﺒﻪ ﺷﺪ ﻛﻪ ﻧﺸﺎﻥ ﺍﺯ ﺭﺍﺑﻄﻪ ﻣﻌﻨﻲ ﺩﺍﺭ ﺩﺍﺷﺖ P<0.001)(. ﻣﻴﺎﻥ ﺯﻣﺎﻥ ﻗﺎﺑﻞ ﺍﺳﺘﻔﺎﺩﻩ ﺷﺪﻥ ﻓﻴﺴﺘﻮﻝ ﺑﺎ ﺟﻨﺴﻴﺖ ﺑﻴﻤﺎﺭﺍﻥ، ﻣﺼﺮﻑ ﻫﭙﺎﺭﻳﻦ ﻗﺒﻞ ﺍﺯ ﺟﺮﺍﺣﻲ، ﺳﺎﺑﻘﻪ ﻛﺎﺭﮔﺬﺍﺭﻱ ﻛﺎﺗﺘﺮ ﻭﺭﻳﺪ ﻣﺮﻛﺰﻱ ﻭ ﺳﺎﺑﻘﻪ ﻗﺒﻠﻲ ﺩﻳﺎﻟﻴﺰ ﺭﺍﺑﻄﻪ ﻣﻌﻨﻲ ﺩﺍﺭﻱ ﺩﻳﺪﻩ ﻧﺸﺪ. ﻧﺘﻴﺠﻪ ﮔﻴـﺮﻱ: ﻳﺎﻓﺘﻪ ﻫﺎﻱ ﻣﻄﺎﻟﻌﻪ ﻣﺎ ﻧﺸﺎﻥ ﻣﻲ ﺩﻫﺪ ﻛﻪ ﺳﻦ ﺑﻴﻤﺎﺭﺍﻥ، ﻓﺸﺎﺭ ﺧﻮﻥ ﺑﻴﻤﺎﺭﺍﻥ، ﺍﺑﺘﻼ ﺑﻪ ﺩﻳﺎﺑﺖ ﻭ ﺑﻴﻤﺎﺭﻱ ﻗﻠﺒﻲ ﻋﺮﻭﻗﻲ ﺑﺎ ﺯﻣﺎﻥ ﻗﺎﺑﻞ ﺍﺳﺘﻔﺎﺩﻩ ﺷﺪﻥ ﻓﻴﺴﺘﻮﻝ ﺍﺭﺗﺒﺎﻁ ﺩﺍﺷﺘﻪ ﻭ ﺗﻮﺟﻪ ﺑﻪ ﺍﻳﻦ ﻣﻮﺿﻮﻉ ﻣﻲ ﺗﻮﺍﻧﺪ ﺩﺭ ﺷﻨﺎﺳﺎﻳﻲ ﺑﻴﻤﺎﺭﺍﻥ ﺩﺭ ﻣﻌﺮﺽ ﺯﻣﺎﻥ ﻗﺎﺑﻞ ﺍﺳﺘﻔﺎﺩﻩ ﺷﺪﻥ ﻃﻮﻻﻧﻲ ﻓﻴﺴﺘﻮﻝ، ﻛﻤﻚ ﻛﻨﻨﺪﻩ ﺑﺎﺷﺪ.

Introduction & Objective: Vascular access is a crucial step for performing the hemodialysis. Routinely, any patient undergoing hemodialysis should operate for native Arteriovenous Fistula (AVF). The aim of this study was to determine maturation time of the AVF and its relationship with underlying diseases. Materials & Methods: In a prospective cross-sectional study 87 patients with AVF were evaluated. The side of AVF was Antecubital in all cases. The time between AVF operation and the opening of hemodialysis was considered as maturation time. The relationship between maturation times and Diabetes mellitus, hypertension, dyslipidemia, history of coronary artery disease (CAD) and renal failure causes were evaluated. Results: 26 patients (29.9%) were female and 61 (70.1%) were male. The mean maturation time was 5.6±2.4 weeks. The mean maturation time in Diabetic and non-Diabetic patients was 6.1±2.4 and 4.9±2.2 weeks, respectively (P=0.016), in CAD and non-CAD patients were 6.8±2.5 and 5.1±2.1 weeks, respectively (P= 0.001) and in the groups with middle arterial pressure <110 mmHg and >=110 mmHg were 6.1±2.4 and 3.6±0.8 weeks, respectively (P= 0.001). The correlation coefficient between the maturation time and age was 0.453 (P <0.001) which was meaningful. There was no significant relationship between the maturation time and the gender, history of heparin usage at the time of operation. The central vein catheterization and the history of hemodialysis. Conclusions: Our studies showed that the patient’s age and underlying diseases such as blood pressure, diabetes mellitus and CAD may affect the maturation time of AVF. That might be helpful if it is taken into consideration before prospective hemodialysis planning