血液透析五年以上成人永久性血管通路患者生存质量与血流量的相关因素分析

The Related Research of Life Quality and Blood Flow in Adult Hemodialysis Patients with More Than Five Years of Permanent Vascular Access

目的研究永久性血管通路在五年以上透析后血流量大小对患者生存质量的影响。方法选择永久性血管通路透析五年以上患者88例,其中实验组为血管通路血流量≤300 mL/min患者45例,对照组为血管通路血流量在300～500 mL/min患者43例,两组患者均采用常规透析,并对两组患者并发症、血红蛋白、尿素氮、血肌酐、白蛋白、残余肾功能等生存质量因素进行分析。结果透析后,实验组尿素氮和血肌酐水平高于对照组(24.87±7.97 mmol/L和675±232μmol/L比17.34±9.53 mmol/L和368±243μmol/L;P<0.05),实验组血红蛋白水平(70.62±12.03 g/L)低于对照组(76.03±13.05 g/L;P<0.05),两组白蛋白水平无明显差异(P>0.05)。实验组残余肾功能降低了90.9%,明显高于对照组的36.4%。在对狭窄治疗后再狭窄机会以及血液再通时的流速比较中发现实验组明显差于对照组(P<0.05)。结论永久性血管通路进行透析且血管通路血流量≤300 mL/min的患者在透析过程中应当注意身体机能的变化,在适当的时机应调整透析方案,增加透析频率和对并发症的预防,提高患者的生存质量。

Aim To study the effect of blood flow on life qualifty in hemodialysis patients with more than five years of permanent vascular access. Methods 88 hemodialysis patients with more than five years of permanent vascular access were selected and divided into experimental group （ blood flow of vascular access ≤ 300 mL/min, n = 45 ） and control group （ blood flow of vascular access was 300 - 500 mL/min, n = 43）. Patients in the experimental group and the control group were treated with conventional dialysis, and the complications, Hb, BUN, Scr, ALB, RRF and other factors affecting life quality were analyzed. Results After dialysis, BUN and Scr levels in the experimental group were higher than those in the control group （24. 87 ±7. 97 mmol/L and 675 ±232 μmol/L vs 17.34±. 53 mmol/L and 368±243 μmol/L;P 〈 0. 05 ）, Hb levels in the experimental group were lower than those in the control group （70. 62 ± 12.03 g/L vs 76. 03 ± 13.05 g/L;P 〈 0. 05）, ALB levels had no significant difference in the two groups （P 〉 0. 05）. RRF in the ex perimental group reduced 90. 9%, significantly higher than 36.4% of control group. The chance of restenosis and blood flow during reperfusion in the experimental group were significantly worse than those in the control group （P 〈 0. 05 ）. Conclusions Patients with permanent vascular access for dialysis and vascular access blood flow ≤ 300 mL/min should pay attention to changes in bodily functions in the dialysis process. Dialysis program should be adjusted at the appropriate time by increasing dialysis frequency and prevention of complications to improve life quality.