ESRD患者首次血液透析血管通路的选择与影响因素分析

Selection of First Hemodialysis Vascular Access and Analysis of Influencing Factors in ESRD Patients

目的探究终末期肾脏病患者首次血液透析血管通路的选择与影响因素。方法选取2020年1月-2021年10月医院肾内科接收的血液透析患者308例,对患者首次透析血管通路类型进行统计,同时对其转归情况,以及发生治疗方案改变情况进行记录。结果①分析发现308例化患者血液透析中选择AVF方法数量48例,占比15.58%,使用CVC方法透析260例,占比84.42%,其中患者平均年龄(51.68±16.14)岁,且大部分患者(52.08%)均是由于原发性肾小球疾病病变进行血液透析;因糖尿病肾病进行透析占比18.75%,观察AVF组以及CVC组,发现患者性别,GFR以及病因,地域分布情况均是影响患者血液透析方式的主要原因;②在260例CVC血液透析中,发现使用无涤纶套导管患者231例,占比88.85%,使用带涤纶套导管患者29例,占比11.15%,说明大部分患者在进行血液透析血管通路选择中多为无涤纶套导管;③针对无涤纶套导管患者进行6个月随访,发现使用AVF患者数量为201例,使用带涤沦套导管17例,腹膜透析15例所有患者随访6个月发现大部分患者依然使用AVF,共计221例,带涤沦套导管23例,腹膜透析23例(失访或者死亡者除外);④初次血液透析选择CVC主要受到性别,区域分布以及eGFR影响,数据存在统计学意义(P<0.05)。结论ESRD患者首次血液透析血管通路选择中AVF相对低,但是经过医院治疗以及结合患者自身情况,选择AVF血管通路患者增多,对患者血液透析有效性提供了重要保障。

Objective To explore the choice and influencing factors of the first hemodialysis vascular access in ESRD patients.Methods 308 hemodialysis patients accepted by the Department of Nephrology in the hospital from January 2020 to October 2021 were selected.The types of vascular access for the first dialysis of the patients were counted,and their outcome and treatment plan changes were made at the same time.Results①Analysis found that among 308 patients with hemodialysis,48 cases chose AVF method,accounting for 15.58%of the total,and 260 cases used CVC method for dialysis,accounting for 84.42%of the total,and the average age of the middle patients was(51.68±16.14)years old.And most of the patients(52.08%)were undergoing hemodialysis due to primary glomerular disease lesions;and 18.75%of patients were undergoing dialysis due to diabetic nephropathy.Observing the AVF group and the CVC group,it was found that the patient’s gender,GFR,etiology,and region.The distribution is the main reason affecting the hemodialysis method of patients;②Among 260 CVC hemodialysis cases,231 patients were found to use non-polyester sheathed catheters,accounting for 88.85%,and 29 patients were using cuffed catheters,accounting for 11.15%,indicating that most patients are in the selection of hemodialysis vascular access.Most of them are non-polyester sheathed catheters;③The 6-month follow-up of patients without polyester sheathed catheters found that the number of patients using AVF was 201,17 were using cuffed catheters,and 15 were for peritoneal dialysis.Most patients were followed up for 6 months.Patients still use AVF,a total of 221 cases,23 cases with cuff catheters,23 cases with peritoneal dialysis(except those who were lost to follow-up or died);④The choice of CVC for initial hemodialysis is mainly affected by gender,regional distribution and eGFR,and the data is statistically significant(P<0.05).Conclusion The AVF in the first hemodialysis vascular access for ESRD patients is relatively low.However,after hospital treatment and combined with the patient’s own conditions,more patients choose AVF vascular access,which provides an important guarantee for the effectiveness of hemodialysis.