不同血管通路血液透析患者透析充分性评估及并发症发生率的比较

Comparison of Dialysis Adequacy and Complication Rates of Hemodialysis Patients with Different Vascular Access Ports

目的对比不同血管通路运用于血液透析中的透析充分性及并发症发生率。方法选择昆明市五华区人民医院和昆明市延安医院2018年1月至2019年4月纳入的156例血液透析患者作为研究对象,遵照血管通路的不同分成三组各52例,A组采取自体动静脉内瘘,B组采取聚四氟乙烯移植血管瘘,C组采取带袖套隧道导管,记录三组透析后的血浆清蛋白、血红蛋白、总胆固醇、甘油三酯、高密度、低密度脂蛋白、C反应蛋白、尿素、Kt/V(尿素清除指数)及尿素降低率水平,并随访3个月,观察并发症发生率(感染及血栓栓塞),对比两组透析结果。结果三组透析后的血浆清蛋白、血红蛋白、总胆固醇、甘油三酯、高密度、低密度脂蛋白、C反应蛋白、尿素、Kt/V及尿素降低率水平对比差异无统计学意义(P>0.05)。A组的感染发生率低于B、C组,但C组血栓栓塞发生率低于B、C组(P<0.05)。结论自体动静脉内瘘可成为血液透析中首选的血管通路方式,若患者无法创建时可考虑带袖套隧道导管,来保证患者透析的充分性,减少并发症产生,提升安全性。

Objective To compare the dialysis adequacy and complication rates of hemodialysis patients with different vascular access ports.Methods In this study,156 hemodialysis patients in Wuhua District People’s Hospital of Kunming and Yan’an Hospital of Kunming City from January 2018 to April 2019 were included and divided into three groups according to different vascular access ports:group A,B and C,with 52 patients in each group.Autologous arteriovenous fistula,polytetrafluoroethylene vascular fistula transplantation and sleeved tunneled duct were employed in g roup A,B,C,respectively.Plasma albumin,hemoglobin,total cholesterol,triglyceride,high-density and low-density lipoprotein,C-reactive protein,urea,Kt/V,urea reduction rate and dialysis results as well as complications(infection and thromboembolism)during three-month follow-up were evaluated.Results There was no significant difference among the values of plasma albumin,hemoglobin,total cholesterol,triglyceride,high-density and low-density lipoprotein,C-reactive protein,urea,Kt/V,urea reduction rate in the three groups(P>0.05).The infection rate in group A was lower than those of group B and group C and the occurrence of thromboembolism in group C was lower than those in group A and group B(P<0.05).Conclusion Autologous arteriovenous fistula can be primarily recommended in hemodialysis.Otherwise,sleeved tunneled duct can be applied to ensure dialysis adequacy,reduce complications and increase clinical safety.