双静脉穿刺在血液透析临时血管通路中的应用

Application of veno-venous puncture as the temporary vascular access in hemodialysis patients

目的目前,未能及时建立长期血管通路的CKD5期患者只能依靠中心静脉置管开始透析,对患者预后存在不良影响。本研究的目的为探讨双静脉穿刺作为初始透析患者血管通路替代选择的可行性。方法选取2014年6月~2015年6月间南京军区福州总医院因各种原因未及时建立自体动静脉内瘘或移植物动静脉内瘘的初始透析患者66例,使用随机数字表法分为双静脉穿刺组33例及长期管组33例。入组后安排内瘘手术,由开始测试至内瘘成熟期间对2组患者间的透析充分性、通路再循环阳性率及通路相关并发症发生率进行2个月的随访比较。结果 2组患者入组时一般情况及各项检查指标差异均无统计学意义,具有可比性。对2组患者进行2个月随访比较,双静脉穿刺组与长期管组相比,单室尿素清除指数(spKt/V)、平衡后尿素清除指数(eKt/V)、尿素氮下降率(urea reduction rate,URR)差异均无统计学意义(P值分别为0.501,0.509,0.747),通路通畅性不良发生率低于长期管组(0%比12.12%,χ~2=4.192,P=0.041),2组间通路再循环阳性率及通路相关感染发生率差异无统计学意义。结论双静脉穿刺操作简单,建立通路后即可开始透析,可作为初始透析或通路失功患者的临时血管通路替代选择。

Background At present, patients who do not establish long-term vascular access can only rely on central venous catheter（CVC） as the temporary vascular access for dialysis. However, CVC has an adverse impact on the prognosis of patients. The purpose of this study was to investigate the feasibility of venovenous puncture（VVP） as an alternative for temporary vascular access in incident hemodialysis patients.Methods A total of 66 incident hemodialysis patients treated in Fuzhou General Hospital of Nanjing Military Command during the period from June 2014 to June 2015 were enrolled in this study. Patients were randomly divided into VVP group（n=33） and CVC group（n=33）. Dialysis adequacy, access recirculation rate and access complications in a follow-up period of 2 months were observed and compared between the two groups.Results There were no significant differences in sp Kt/V, e Kt/V and urea reduction ratio（URR） between the two groups at 0, 1 and 2 months after dialysis. After 2 months, the access dysfunction rate in VVP group was lower than that in CVC groups（0% vs. 12.12%, χ^2=4.192, P=0.041）. The dialysis adequacy and vascular access complications rate were similar between the two groups. Conclusion VVP is easy to perform and it can be an alternative choice for temporary vascular access in incident hemodialysis patients.