慢性肾衰竭血液透析中自体动静脉内瘘和带隧道带涤纶套透析导管临床应用对比研究

Clinical Comparison of Autologous Arteriovenous Fistula and Tunnel-cuffed Catheter for Hemodialysis in Patients with Chronic Renal Failure

目的对比慢性肾衰竭血液透析中自体动静脉内瘘(AVF)和带隧道带涤纶套透析导管(TCC)的临床应用效果。方法选取2021年1月—2022年8月收治的行血液透析治疗的慢性肾衰竭112例,根据治疗方法不同将其分为AVF组(采用AVF血液透析)和TCC组(采用TCC血液透析)2组各56例。比较2组透析6个月后血液透析相关指标[尿素清除率(Kt/V)、尿素下降率(URR)、透析有效血流量(Qb)],透析前和透析3、6个月后营养状态指标、肾功能指标、血栓弹力图参数(α角和k值)及血清高级氧化蛋白产物(AOPP)、褪黑素(MT)水平,以及透析期间并发症发生情况。结果透析6个月后,AVF组Kt/V、URR和Qb高于或大于TCC组(P<0.01)。透析3和6个月后,AVF组营养状态指标、k值和血清MT高于TCC组,肾功能指标、α角和血清AOPP低于TCC组(P<0.05,P<0.01)。透析期间,AVF组总并发症发生率(7.14%,4/56)低于TCC组(23.21%,13/56)(P<0.05)。结论慢性肾衰竭血液透析患者采用AVF治疗效果优于TCC,可促进机体代谢废物排出,改善营养状态及肾功能,减少主要心血管不良事件和骨质疏松症发生。

Objective To compare the clinical effect of autologous arteriovenous fistula(AVF)and tunnel-cuffed catheter(TCC)in hemodialysis in patients with chronic renal failure(CRF).Methods In total,112 patients with CRF who underwent hemodialysis from January 2021 to August 2022 were selected and divided into AVF group(undergoing hemodialysis using AVF,n=56)and TCC group(undergoing hemodialysis using TCC,n=56)according to different treatment methods.Hemodialysis-related indexes[urea clearance rate(Kt/V),urea reduction rate(URR),blood flow(Qb)for effective hemodialysis],nutritional status indicators,renal function indicators,thromboela-stogram parameters(angle α and k value),serum levels of advanced oxidized protein products(AOPP)and melatonin(MT)before dialysis and at 3 and 6 months after hemodialysis,as well as complications during hemodialysis were compared between the two groups at 6 months after hemodialysis.Results At 6 months after hemodialysis,Kt/V,URR and Qb in AVF group were higher or greater than those in TCC group(P<0.01).At 3 and 6 months after hemodialysis,nutritional status indicators,k value and serum MT in AVF group were higher than those in TCC group,while renal function indicators,angleαand serum AOPP were lower than those in TCC group(P<0.05,P<0.01).During hemodialysis,the total complication rate in AVF group(7.14%,4/56)was lower than that in TCC group(23.21%,13/56)(P<0.05).Conclusion The therapeutic effect of AVF is better than TCC in patients with CRF undergoing hemodialysis,which can promote the elimination of metabolic waste,improve nutritional status and renal function,reduce major adverse cardiovascular diseases and osteoporosis.