以带涤纶套隧道双腔深静脉导管为通路的血液透析患者透析充分性研究

Clinical study on dialysis adequacy of hemodialysis patients who used silicone dual-lumen catheter with a Dacron cuff

目的探讨以带涤纶套隧道双腔深静脉导管为血管通路与以动静脉内瘘为血管通路的血液透析患者透析充分性、营养状态及并发症的差异。方法选我院125例维持性血液透析患者,其中带涤纶套隧道双腔深静脉置管患者36例,动静脉内瘘患者89例,观察血液透析患者的营养状态、透析充分性指标以及并发症发生情况并进行分析对比。结果带涤纶套隧道双腔深静脉置管患者与动静脉内瘘患者相比较,血红蛋白、白蛋白、总蛋白、总胆固醇、三酰甘油、C反应蛋白、尿素清除指数、尿素降低率及蛋白质分解代谢率值无显著差异,两组透前及透后尿素氮、肌酐及尿酸均无明显差异。带涤纶套隧道双腔深静脉置管患者血流不畅、血栓栓塞及感染的发生率高于动静脉内瘘患者(P<0.001),而出血的发生率低于动静脉内瘘患者(P<0.001)。结论以带涤纶套经隧道双腔导管为通路是血液透析比较理想的血管通路,只要采取有效的预防导管功能不良及相关感染的措施,导管的使用寿命可以明显延长。

Objective To investigate the differences in nutrition status, dialysis adequacy and complications associated with catheter between silicone dual - lumen catheter with a Dacmn cuff and arter/ovenous fistula as long term vascular access for hemodialysis patients. Methods 125 long -term hemodialysis patients treated in our hospital were enrolled in the study. Of the 125 patients, 36 patients used silicone dual -lumen catheter with a Dacron cuff, 89 patients used arteriovenous fistula. Comparative study of nutritional status, dialysis adequacy and complications between silicone dual - lumen catheter with a Dacron cuff and arteriovenous fistula patients were conducted. Results No significant difference was found in serum albumin, total protein, total cholesterol, triglyceride, C reactive protein, KT/V, URR, PCR, BUN, Cr, and UA before and after hemodialysis between silicone dual - lumen catheter with a Dacron cuff and arteriovenous fistula groups. The frequency of unsmooth flow of blood, thromboembolism and infection incidence rate in patients with silicone dual - lumen catheter and a Dacron cuff was higher than those in patients with arteriovenous fistula （ P 〈 0. 001 ）, and the frequency of bleeding was lower （ P 〈 0. 001 ）. Conclusion Silicone dual - lumen catheter with a Dacron cuff as a long - term vascular access for hemodialysis patients is an ideal vascular access. If effective measures are taken to prevent catheter - related infection and dysfunction, the service life of catheter can be significantly prolonged.