不同血管通路对血液透析患者透析充分性及并发症的影响

Comparison of dialysis adequacy and access-related complications among hemodialysis patients with different vascular access approaches

目的通过对不同血管通路血液透析患者透析充分性评估及并发症发生率的比较,探讨维持性血液透析患者较好血管通路。方法选择成都军区昆明总医院肾内科2009年6月至2010年6月间新建立的长期血管通路行血液透析的患者,随访12月,测定自体动静脉内瘘(AVF)(53例)和颈内静脉带袖套隧道导管(CTC)(21例)2种血管通路的血液透析患者的Kt/V值,并比较2种长期血管通路的并发症的发生率。结果 74例维持性血液透析患者中,经AVF透析的患者53例;经颈内静脉CTC透析的患者21例。AVF患者年龄、感染等并发症较CTC组低(P<0.05);AVF患者栓塞的发生率较CTC组患者栓塞发生率低,2种血管通路透析患者无显著差异(P>0.05)。结论经AVF透析患者的年龄较轻、栓塞和感染的发生率较低;AVF应是长期血管通路的首选,在AVF无法建立时,CTC也是理想血管通路,两种透析通路均能达到较好的透析效果。

Objective To compare the dialysis adequacy and complications in hemodialysis patients with different vascular access, and try to find out an ideal vascular access approach. Methods Patients who underwent long-term hemodialysis access operation between June, 2009 and June, 2010 in Department of Nephrology General Hospital of PLA were enrolled in this study. Kt/V value and the morbidity of access-related complications were evaluated and compared in a follow-up period of 12 months among patients using vascular access of native arteriovenous fistula (AVF), and cuffed and tunneled catheter (CTC) in an internal jugular vein. Results In the 74 maintenance hemodialysis patients, 53 cases used native AVF, and 21 cases used CTC as the long-term vascular access for hemodialysis. Patients using native AVF for vascular access were younger, and had lower infection rate than the patients using CTC for the access (P<0.05). Thrombosis rate was lower in AVF group than in the CTC group, but the difference was insignificant (P>0.05). Conclusion Patients using native AVF for vascular access for hemodialysis were younger, and had lower rate of thrombosis and infection. Therefore, native AVF is preferable for long-term vascular access. When this type of vascular access is difficult to be established, CTC can also be chosen with relatively satisfactory effect of dialysis.