单中心血液透析患者血管通路的调查分析

Investigation on vascular access of single center hemodialysis patients

目的分析血液透析患者血管通路使用情况。方法回顾性分析765例血液透析患者的人口学和临床资料、透析方案、血管通路使用概况,分析首次血液透析及维持性血液透析（MHD）患者中不同类型血管通路的分布情况,并按性别、年龄、透龄对各种血管通路的选择进行分层分析,随访动静脉内瘘及导管使用功能和并发症。结果新入首次透析患者187例（24.44%）,首次使用各种血管通路的比例为自体动静脉内瘘（AVF）56.15%,带卡夫的深静脉透析导管（TCC）28.88%,临时透析导管14.97%。578例MHD患者血管通路的比例分别为AVF 88.41%,TCC 10.55%,移植物内瘘（AVG）1.04%。AVF患者糖尿病肾病、高血压肾病、慢性肾小球肾炎三大原发病的比例与TCC患者差异均有统计学意义（均P〈0.05）。留治的422例MHD患者年龄〈30岁、30~60岁、61~80岁和〉80岁的患者中AVF的使用率分别为91.67%、89.95%、78.57%、65.00%,TCC的使用率分别为8.33%、9.13%、20.13%、35.00%。本组患者全年AVF并发症的发生率为16.40%,导管相关并发症的发生率54.10%。结论 AVF是透析患者的主要血管通路类型,TCC是第二位的通路类型,AVG使用比例最低。如何积极有效的预防并发症,建立稳定可靠的血管通路,提高患者的生存时间和生活质量依然是临床工作者的研究目标和努力方向。

Objective To review the application of vascular access on hemodialysis patients in our hemodialysis center, and analyze existing problems to instruct clinical work. Methods To retrospectively analyze 765 hemodialysis patients＇ demographic and clinical data, dialysis solutions, and the application of vascular access; analyze the distribution of different types of vascular access among patients who had hemodialysis for the first time and maintenance hemodialysis （MHD） patients; carry out hierarchical analysis of choices of vascular access according to gender, age, and the age ofhemodialysis and follow up arteriovenous fistula and catheter functions and complications. Results One hundred and eighty-eight patients （24.44%） accepted hemodialysis for the first time, and the percentages of the application of different types of vascular access were 56.15% for arteriovenous fistula （AVF）, 28.88% for tunneled cuffed catheter （TCC）, and 14.97% for provisional cateter. Among the 578 MHD patients, types of vascular access were 88.41% for AVF, 10.55% for TCC, and 1.04% for arteriovenous graft （AVG）. There was statistical significant difference between the incidence rates of AVF patients and TCC patients of three primary diseases of diabetic neph- ropathy （DN）, hypertensive nephropathy （HN） and chronic glomerulonephritis （CGN） （P 〈 0.05）. AVF utilization rate among 422 MHD patients aged 〈30, 30 - 60, 61 - 80 and 〉 80 years old patients was 91.67%, 89.95%, 78.57% and 65.00%, respectively; TCC usage rate was 8.33%, 9.13%, 20.13% and 35.00%, respectively. The incidence of complications of patients with AVF was 16.40%, and the incidence of catheter-related complications was 54.10%. Conclusions AVF is the most frequently used vascular access type for dialysis patients, followed by TCC, and AVG is the lowest proportion. How to effectively prevent the complications, build stable and reliable vascular access, and improve patients＇ survival time and quality of life is still the research target and direction of clinical workers.