维持性血液透析长期深静脉留置导管与动静脉内瘘对比分析

Comparison between long-term deep vein indwelling catheter and arterovenous fistula on patients undergoing maintenance hemdialysis

目的探讨维持性血液透析长期深静脉留置导管对患者微炎症、营养状态及并发症的影响。方法选择维持性血液透析患者80例,其中长期深静脉留置导管36例(导管组),动静脉内瘘44例(内瘘组),比较两组患者TNF-α、IL-6、hs-CRP、Hb、Alb、PA、TF、Hb,计算患者KT/V、URR、nPCR、SGA评分及并发症、住院事件。结果导管组与内瘘组比较,患者TNF-α、IL-6、hs-CRP明显升高,差异有统计学意义(P<0.05)。导管组患者hs-CRP水平与Alb、PA、TF及Hb均呈显著负相关。同内瘘组比较,导管组患者的Alb、PA、TF及Hb明显下降,蛋白分解率增高,SGA评分营养不良例数增加(P<0.05)。两组透析患者KT/V、URR差异均无统计学意义,但导管组长期并发症包括血栓栓塞、导管感染及住院事件显著增高(P<0.05)。结论长期深静脉留置导管能影响患者微炎症、营养状态,长期并发症多、住院事件高,对患者生存质量有一定影响,应严格把握使用指征。

Objective To study the effect of long - term deep vein indwelling catheter on maintenance hemdialysis patients＇ mircoflammation, nutritional status and complications. Methods Eighty maintenance hemdialysis patients were subjects. Thirty -six of them received long - term deep vein indwelling catheter, and forty - four were with arterovenous fistula. Indexes of the two groups were compared, such as TNF-α, IL-6, hs- CRP, Hb, Alb, PA, TF, Hb. The subjects＇ KT/V, URR, nPCR, SGA scores and the number of complications and hospital events were calculated Results TNF - α, IL - 6, hs - CRP were significantly higher in catheter group than in fistula group, and the difference was statistically significant （ P 〈 0.05 ）. The hs - CRP in subjects with indwell- ing catheter had a significant negative relation with Alb, PA, TF and Hb. Compared with fistula group, the Alb, PA, TF and Hb in subjects with catheter group decreased remarkedly, and the protein catabolic rate increased, the number of subjects with low SGA scores and malnutrition increased （P 〈 0. 05）. Both two groups＇ KT/V, URR did not have statistically significant difference. In the catheter group such complications as thromboembolism, catheter infection and the number of hospital events increased significantly （P 〈 0.05）. Conclusions The long -term deep vein indwelling catheterization affect subjects＇ mircoflammation and nutritional status, which may lead to more long - term complications and higher hospital events. Since long - term deep vein indwelling catheterization has an adverse effect on subjects＇ living quality, its indications should be controlled strictly.