尿毒症患者首次血液透析的血管通路临床研究

The first clinical study in patients with uremia hemodialysis vascular access

目的探讨首次血液透析患者血管通路建立和使用情况,研究影响建立血管通路的相关因素,为临床建立血液透析通路提供依据。方法选取2012年1月至2015年6月间本院进行首次血液透析的尿毒症患者为研究对象,将所选患者使用的血管通路种类、血管通路转归以及替代治疗方式的转换进行整理、记录和分析。结果入选240例血液透析患者中,透析初始肾小球滤过率(glomerular filtration rate,GFR)平均(6.55±3.44)ml/min,首次透析采用自体动静脉内瘘的25例,中心静脉导管的215例,包括184例(85.6%)无袖套导管和31例(14.4%)带袖套导管。随访6个月,血液透析后6个月中,随访的224例患者最终有11例患者接受了肾移植,14例改为腹膜透析,其余199例患者继续血液透析治疗,其中141例患者使用自体动静脉内瘘作为血管通路,47例患者使用带袖套导管作为血管通路。透析时患者GFR小于5ml/min均为首次血液透析时使用中心静脉导管的危险因素。结论尿毒症患者在首次血液透析时使用自体动静脉内瘘的比例较低,但最终大多数患者使用其作为维持性血液透析的长期血管通路。提高计划性通路建立的比例,增加开始血液透析时自体动静脉内瘘的使用比例,仍是临床目前努力的方向和目标。

Objective To explore the establishment and use of vascular access in patients with the first hemodialysis, and to explore the related factors that influence the establishment of vascular access, and to provide evidence for the establishment of hemodialysis access.Method January 2012 to June 2015 in our hospital dialysis center hemodialysis uremic first for the study, patients will be selected using the vascular access type, vascular access outcomes, as well as alternative treatment conversion organize and record for analysis. Result The selected 240 cases of hemodialysis patients, average dialysis initial e GFR was（6.55±3.44）ml/min, the first dialysis using 25 cases of arteriovenous fistula, central venous catheter 215 cases, including 184 cases（85.6%） non-cuff catheter（NCC） and 31 patients（14.4%） with sleeve jacket conduit（TCC）. Followed up for 6 months, after six months of hemodialysis, 224 patients were followed up for 11 patients ultimately received a kidney transplant, 14 to peritoneal dialysis, and the remaining 199 cases of hemodialysis patients who continued treatment, including 141 patients with AVF as vascular access, 47 patients using the TCC as vascular access. Risk factors for the use of central venous catheters in dialysis patients with GFR less than 5ml/min for the first time. Conclusion Uremic hemodialysis patients in the first use of the movable lower proportion of arteriovenous fistula, but most patients eventually use it as a long-term hemodialysis vascular access. To improve the proportion of the planned pathway, and to increase the proportion of autologous arteriovenous fistula in hemodialysis patients, is still the direction and goal of the current clinical efforts.