不同血管通路血液透析患者透析充分性及并发症的比较

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

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理想的血管通路。方法选择上海交通大学医学院附属瑞金医院肾内科2006年1月至2008年3月间经新建立的长期血管通路行血液透析的患者,随访12～38月,评估以自体动静脉内瘘(AVF)、聚四氟乙烯(PTFE)移植血管和颈内静脉带袖套隧道导管(CTC)为血管通路的血液透析患者的Kt/V值,比较三种长期血管通路的并发症的发生率。结果98例维持性血液透析患者中,经AVF透析的患者68例;经PTFE移植血管透析的患者12例;经颈内静脉CTC透析的患者18例。AVF患者的年龄及感染的并发症较PTFE移植血管和CTC组低(P<0.01);AVF患者栓塞的发生率较PTFE移植血管低(P<0.01);CTC组患者在随访期间虽未发生栓塞并发症,但3例患者血流量不足;三种血管通路透析患者的Kt/V值大都>1.2,以AVF为最高(与CTC相比P<0.01)。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,PTFE移植血管和CTC仍可作为较好的长期血液透析通路,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 an operation of long-term hemodialysis access between Jan. 2006 and Mar. 2008 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 12-38 months among patients using vascular access of native arteriovenous fistula （AVF）, polytetrafluoroethylene （FIFE） grafts, and cuffed and tunneled catheter （CTC） in an internal jugular vein. Results In the 98 maintenance hemodialysis patients, 68 cases used native AVF, 12 used PTFE grafts, and 18 cases used CTC as the long-term vascular access for hemodialysis. Patients accepted hemodialysis by native AVF were younger and had lower infection rate, compared with those used PTFE grafts and CTC as the vascular access （P〈 0.01）. Thrombosis formation was less in patients with native AVF than in those with PTFE grafts （P〈0.01）. In patients with CTC, no access thrombosis was found, but inadequate access flow presented in 3 cases. Kt/V value was more than 1.2 in all patients, but was highest in native AVF group （P 〈0.01, as compared with that in CTC group）. 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, FIFE grafts or CTC can also be chosen with relatively satisfactory effect of dialysis.