不同血管通路血液透析患者的预后分析

Investigation of status and prognosis for hemodialysis patients with different vascular access

目的评估不同类型血管通路对血液透析患者预后的影响。方法回顾性分析成都医学院第一附属医院血透中心2014年1月~2019年1月进入维持性血液透析的终末期肾脏病患者的基本资料、实验室检验结果、血管通路类型以及患者的预后情况,并分析血液透析患者死亡的风险因素。结果纳入179名在维持性血液透析之前无其他肾脏替代治疗方式的终末期肾脏病患者。起始使用无涤纶套导管透析治疗患者的平均比例为48.04%(86/179),带隧道带涤纶套导管平均比例为19.55%(35/179),动静脉内瘘平均比例32.41%(59/179)。进入维持性血液透析患者使用带隧道导管比例29.05%(53/179),动静脉内瘘比例70.95%(127/179)。使用不同血管通路进行维持性血液透析的患者相比较,通过Kaplan-Meier生存分析提示:与使用带隧道带涤纶套导管患者相比较,使用内瘘维持性透析的患者具有更高的生存率。通过多元Cox回归模型分析提示:使用带隧道带涤纶套导管透析患者的死亡风险较使用内瘘透析患者死亡风险增加2.176倍。结论患者初次血液透析及维持血液透析的动静脉内瘘使用率较低,提高初次血液透析及维持血液透析患者的动静脉内瘘比例将是血透医生未来的工作重点之一;使用动静脉内瘘透析的患者具有更好的预后,临床应将动静脉内瘘作为透析患者血管通路的"首要选择",在此基础之上兼顾"个体化"选择。

Objective To investigate the status of vascular access in hemodialysis patients in our center and evaluate the prognosis of different types of vascular access.Methods The basic data,laboratory test results,vascular access types and prognosis of patients with end-stage renal disease who entered the hemodialysis center of The First Affiliated Hospital of Chengdu Medical College from January 2014 to January 2019 were retrospectively analyzed,and the risk factors of death in hemodialysis patients were analyzed.Results 179 patients with end-stage renal disease without alternative renal replacement therapy before maintenance hemodialysis were enrolled.The average rate of patients who started to use non Dacron catheter was 4804%(86/179).The average proportion of duct with tunnel and polyester sheath was 19.55%(35/179).The average proportion of arteriovenous fistula was 32.41%(59/179).29.05%(53/179)of the patients in maintenance hemodialysis used the catheter with tunnel.The proportion of arteriovenous fistula was 70.95%(127/179).Kaplan Meier survival analysis showed that the patients with internal fistula had a higher survival rate than those with tunnel and Dacron catheter.The multivariate Cox regression analysis showed that the risk of death in patients with tunnel and Dacron catheter was 2.176 times higher than that in patients with internal fistula.Conclusion The utilization rate of arteriovenous fistula in patients with primary hemodialysis and maintenance hemodialysis is low.Improving the proportion of arteriovenous fistula in patients with primary hemodialysis and maintenance hemodialysis will be one of the priorities of hemodialysis doctors in the future.The patients with arteriovenous fistula dialysis have better prognosis.Arteriovenous fistula should be considered as the"first choice"of vascular access for dialysis patients,and on this basis,the"individualized"choice should be taken into account.