昆明地区二级医院血液透析患者血管通路情况分析

Analysis of vascular access in patients receiving hemodialysis in second-level hospitals in Kunming city

目的了解昆明地区血液透析患者血管通路的现状。方法对昆明市4家二级医院2010年5月~2015年5月在透患者血管通路情况进行回顾性多中心分析,统计患者年龄、性别、病因、透析开始时血管通路选择情况及临时性通路改换长期血管通路的情况、长期血管通路的构成情况,并对通路的选择情况进行分析评价。结果共306例患者,开始透析时选择无涤纶套无隧道导管279例（91.2%）,其中54.5%选择股静脉置管,选择带涤纶套导管8例（2.6%）,选择动静脉内瘘透析16例（5.2%）。长期血管通路的构成情况为：动静脉内瘘243例（79.4%）,带涤纶套导管61例（19.9%）,人工血管内瘘2例（0.7%）。结论昆明地区血液透析患者开始透析时血管通路以静脉导管较多;长期血管通路的使用上,以自身血管内瘘为主,带涤纶套导管比例较高,人工血管内瘘较少。需要加强医务人员血管通路知识的培训,加强透析前慢性肾脏病患者管理,及时合理建立血管通路。

Objective To investigate the current situation of vascular access（VA） in patients receiving hemodialysis in Kunming city. Methods A multi-central retrospective analysis was made in the VA situation of patients receiving hemodialysis between May2010 and May 2015 in 4 second-level hospitals in Kunming city. Statistic analyses were made in the age, gender, etiology, the choices of vascular access at the beginning of hemodialysis, the temporary changes of HD passage into the long-term vascular access, and the types and component percentages of the long-term vascular access. The selection of VA was analyzed and evaluated. Results Among the totally 306 cases, there were 279 cases（91.2%） selecting non-cuffed and non-tunneled catheters at the beginning of the hemodialysis, in which 54.5% cases selected the femoral vein catheterization, 8 cases（2.6%） selected tunneled cuffed catheter（TCC）,and 16 cases（5.2%） selected arteriovenous fistula（AVF）. The selection situations of the long-term VA were 243 cases（79.4%） of AVF,61 cases（19.9%） of TCC, and 2 cases（0.7%） of artificial vascular fistulas. Conclusion At the beginning of HD, the most selection of VA in patients in Kunming is venous catheterization. For the choices of long-term vascular access, AVF still prevail, and the cases of artificial vascular fistulas are still less selected, and the proportion of TCC is comparatively higher. The training on the knowledge of vascular access should be enhanced in medical personnel. The management of patients with chronic kidney diseases before the hemodialysis should be reinforced, and the vascular access should be created timely and reasonably.