带隧道带涤纶套导管与自体动静脉内瘘两种血管通路对尿毒症患者炎症状态和并发症的影响

Effects of tunneled cuffed catheter and autologous arteriovenous fistula on inflammatory states and complications in patients with uremia

目的观察带隧道带涤纶套导管(TCC)与自体动静脉内瘘(AVF)两种血管通路对尿毒症患者炎症状态和并发症的影响。方法回顾性分析2016年1月至2018年1月重庆三峡中心医院收治的66例尿毒症维持性血液透析(MHD)患者临床资料,根据其血管通路建立方式分为TCC组(n=29)和AVF组(n=37)。比较两组患者入组时及入组6个月时血清炎症因子[肿瘤坏死因子(TNF-α)、超敏C反应蛋白(hs-CRP)、白介素-6(IL-6)]、肾功能指标[尿素氮(BUN)、肌酐(SCr)]、透析情况[单室尿素清除指数(spKt/V)、尿素下降率(UPR)、平衡后尿素清除指数(eKt/V)]检测结果差异。记录入组6个月内并发症发生情况。结果入组6个月后,TCC组血清TNF-α、IL-6、hs-CRP水平均高于AVF组(P <0.05)。入组6个月后,TCC组血清TNF-α、IL-6、hs-CRP水平均较入组时升高(P <0.05),AVF血清TNF-α、IL-6、hs-CRP水平与入组时差异均无统计学意义(P> 0.05)。两组入组时及入组6个月后血BUN、SCr水平及spKt/V、UPR、eKt/V差异无统计学意义(P> 0.05)。入组6个月内,TCC组并发症发生率高于AVF组(P <0.05)。结论 TCC相对于AVF将加重尿毒症MHD患者的炎症状态,增加并发症发生率,但透析效果与AVF相当,临床因首选AVF,对于AVF难以建立患者,TCC可作为替代选择。

Objective To observe the effects of tunneled cuffed catheter(TCC)and autologous arteriovenous fistula(AVF)on inflammatory states and complications in patients with uremia.Methods The clinical data of 66 patients with uremia and maintenance hemodialysis(MHD)in our hospital from January 2016 to January 2018 were retrospectively analyzed.According to the establishment of vascular access,they were divided into TCC group(n=29)and AVF group(n=37).Serum inflammatory factors[tumor necrosis factorα(TNF-α),hypersensitive C-reactive protein(hs-CRP),interleukin-6(IL-6)],renal function indicators[urea nitrogen(BUN),creatinine(SCr)]and dialysis[single chamber urea clearance index(spKt/V),urea reduction rate(UPR),post-equilibrium urea clearance index(eKt/V)]were compared between the two groups at entering and at 6 months of entering.The occurrence of complications within 6 months of entering was recorded.Results At 6 months of entering,serum levels of TNF-α,IL-6 and hs-CRP in TCC group were higher than those in AVF group(P<0.05).At 6 months of entering,the serum levels of TNF-α,IL-6 and hs-CRP in TCC group were higher than those at entering(P<0.05),and there were no significant differences in the levels of serum TNF-α,IL-6 and hs-CRP in AVF(P>0.05).There were no significant differences in levels of blood BUN and SCr and spKt/V,UPR and eKt/V between the two groups at 6 months of entering(P>0.05).Within 6 months of entering,the incidence rate of complications in TCC group was greater than that in AVF group(P<0.05).Conclusion Compared with AVF,TCC will aggravate the inflammatory state of patients with uremia and MHD,and increase the incidence rate of complications.However,the dialysis effect is comparable to that of AVF.And the clinical preference is AVF.For patients with difficulty in establishing AVF,TCC can be used as an alternative.