Abstract: Background　Arteriovenous fistula is the most common vascular access in maintenance hemodialysis patients.The use time of arteriovenous fistula depends largely on the correct protection.At present，China lacks the best evidence for the maintenance of arteriovenous fistula.Objective　To retrieve and analyze the relevant evidence on protection of arteriovenous fistula in maintenance hemodialysis patients，and to summarize the best evidence.Methods　We performed a systematic search of evidence from computerized databases：British Medical Journal（BMJ） Best Practice，Uptodata，Cochrane Library，Joanna Briggs Institute（JBI） Library，National Institute for Health and Clinical Excellence（NICE），Registered Nurses' Association of Ontario，Canada（RNAO），Scottish Intercollegiate Guidelines Network（SIGN），National Guideline Clearinghouse（NGC），Guideline International Network（GIN），American Center for Disease Control and Prevention（CDC），PubMed and China National Knowledge Infrastructure（CNKI） from October 2017 to September 2018.Results A total of 10 literatures were selected，including one clinical decision support，six clinical practice guidelines，one expert consensus and two systematic reviews.Finally，12 items of best evidence were summarized，which included 10 A-level recommendations and 2 B-level recommendations.The contents covered the 4 aspects：the selection of the time of using arteriovenous fistula，preparation before use arteriovenous fistula，methods of puncture and needle insertion，education and training for patients and nurses.Conclusion　This study summarized the best evidence for protecting arteriovenous fistula in maintenance hemodialysis patients.It is convenient for nurses in hemodialysis room to use and protect the arteriovenous fistula according to the best evidence，and instruct patients to learn how to self-protect the internal arteriovenous fistula，so as to prolong its service life.

Key words: Kidney diseases, Hemodiafiltration, Arteriovenous fistula, Vascular access, Evidence-based medicine

摘要： 背景　动静脉内瘘是维持性血液透析患者最常用的血管通路，动静脉内瘘的使用寿命在很大程度上取决于正确的维护，目前我国缺乏动静脉内瘘维护的最佳证据。目的　检索和分析有关维持性血液透析患者动静脉内瘘维护的相关证据，对最佳证据进行总结分析。方法　于2017年10月—2018年9月，通过计算机检索BMJ最佳临床实践（British Medical Journal best practice）、Uptodata、Cochrane图书馆、JBI（Joanna Briggs Institute）图书馆、英国卫生与临床优化研究所（NICE）、加拿大安大略注册护士协会（RNAO）、苏格兰学院间指南网（SIGN）、美国指南网（NGC）、国际指南网（GIN）、美国疾病控制中心（CDC）、PubMed和中国知网中的所有证据。结果　共筛选到有用的文献10篇，包括临床决策支持1篇、临床实践指南6篇、专家共识1篇和系统评价2篇。最终形成4个方面共12条最佳证据总结，其中10条A级推荐、2条B级推荐，内容包括：动静脉内瘘使用时间的选择、动静脉内瘘使用前准备、穿刺和进针方法、对患者和护士的教育和培训。结论　本研究检索了国内外多个数据库，总结了维持性血液透析患者动静脉内瘘维护的最佳证据，便于血液透析室护士按照最佳证据对患者内瘘进行使用和日常维护，指导患者学会自我维护动静脉内瘘的方法，以延长内瘘的使用寿命。

关键词: 肾疾病, 血液透析滤过, 动静脉内瘘, 血管通路, 循证医学