单中心血液透析患者血管通路使用情况分析

Vascular access clinical investigation in a hemodialysis center in Lanzhou

目的 探讨维持性血液透析患者血管通路的使用情况,为进一步规范化选择建立和使用维护血液透析血管通路提供依据.方法 采用单中心横断面调查及回顾性分析的研究方法,统计分析2012年1月至2012年12月兰州军区兰州总医院血液净化中心新入血液透析患者156例与维持性血液透析患者120例人口统计学资料、血管通路类型,并对自体动静脉内瘘与长期血液透析导管患者原发病种类进行对比分析.结果①首次血液透析血管通路为临时血液透析导管的占84％,成熟的自体动静脉内瘘占16％,无长期血液透析导管;②长期维持性血液透析患者血管通路为自体动静脉内瘘251例（占90.9％）,长期血液透析导管14例（占5.1％）,动静脉直接穿刺及其他11例（占4.0％）,无动静脉移植血管内瘘.自体动静脉内瘘吻合血管依次为桡动脉-头静脉占96％,桡动脉-贵要静脉占2％,尺动脉-贵要静脉占2％;自体动静脉内瘘瘘管吻合方式端侧吻合占54％,端端吻合占46％,无侧侧吻合.自体动静脉内瘘发生并发症17例,血栓12例（占并发症总例数70.6％）,其余依次为缺血（占10.2％）,狭窄（占10.2％）,肿胀手（占0.9％）.长期导管年平均感染率为0.1次/1 000导管日.结论①新入血液透析患者中,选择临时血液透析导管比例较大,预先行动静脉内瘘血管通路准备的血液透析患者比率仍较低,但较前明显提高,需要积极专科宣教提高终末期肾脏疾病患者认识和依存性;②维持性血液透析患者自体动静脉内瘘使用率与文献报道接近,但尚无移植物和人造血管内瘘病例,尚有一定比例的患者直接选择穿刺;③自体动静脉内瘘术失败与年龄无关,基础疾病心血管疾病糖尿病等及反复血管穿刺是自体动静脉内瘘术失败的主要原因.

Objective To retrospectively investigate vascular access usage in our hemodialysis patients in Lanzhou general hospital hemodialysis center.Methods Of 276 patients were included in this center in 2012,of whom 156 were new incident patients,and 120 were prevalent patients.Their vascular access types were recorded.The primary diseases in patients used autologous arteriovenous fistula （AVF） and with long-term indwelling catheterization in maintenance hemodialysis patients were analyzed.SPSS software was used for the statistical analyses.Results （1） Initial hemodialysis patients vascular access,provisional catheter were 84%,16% AVF,0% long-term cuffed catheter,that is mean majority of patients could not accept vascular access preparation.（2） In the maintenance hemodialysis patients,90.9% of them used AVF,5.1% long-term cuffed catheter,4.0% others.The radio-cephalic anastomosis was the most common site for AVF.Conclusions （1） In initial hemodialysis patients,provisional catheters were frequently performed.（2）In maintenance hemodialysis patients,autologous AVF was frequently used,and artificial vessel graft for vascular access was less used.（3） The autologous arteriovenous fistula dysfunction was not associated with age,while underlying disease such as cardiovascular disease diabete and frequently vascular puncture were important risk factor.