不同中心静脉置管方式对维持性血液透析患者的影响

Effects of Different Central Venous Catheterization Methods in Patients undergoing Maintenance Hemodialysis

目的:探讨不同中心静脉置管方式对维持性血液透析(MHD)患者动静脉内瘘通畅率和并发症的影响。方法:选取在宜昌市中心人民医院治疗的318例MHD患者,根据中心静脉置管和动静脉内瘘位置关系分为同侧组(n=37)、对侧组(n=238)和单纯内瘘组(n=43)。比较三组内瘘使用情况和并发症,分析患者动静脉内瘘失功的影响因素。结果:单纯内瘘组内瘘首次使用时间长于同侧组(6.95±2.64周vs 5.25±1.95周)和对侧组(6.95±2.64周vs 4.81±2.07周),且内瘘次数少于同侧组(1.27±0.59次vs 2.03±0.84次)(均P<0.05)。单纯内瘘组和对侧组初级失败率低于同侧组,单纯内瘘组1年畅通率高于同侧组,内瘘失功率及并发症发生率低于同侧组(均P<0.05)。身体质量指数<21 kg/m^(2)、糖尿病、高磷血症、中心静脉置管与内瘘同侧、感染与MHD患者动静脉内瘘失功有关(均P<0.05)。结论:与同侧中心静脉置管相比,单纯动静脉内瘘的畅通率更高,并发症发生率更低。

Objective:To explore the effect of different central venous catheterization methods on patency rate and related complications of arteriovenous fistula in patients with maintenance hemodialysis(MHD).Methods:A total of 318 patients with MHD treated in Yichang Central People's Hospital were selected.According to the position relation between central venous catheterization and arteriovenous fistula,they were divided into the ipsilateral group(n=37),the contralateral group(n=238)and the simple internal fistula group(n=43).The use of internal fistula and the incidence of complications were compared among the three groups.The influencing factors of internal arteriovenous fistula dysfunction were analyzed.Results:The duration of the first using internal fistula was longer in the simple internal fistula group than the ipsilateral group(6.95±2.64 weeks vs 5.25±1.95 weeks)and the contralateral group(6.95±2.64 weeks vs 4.81±2.07 weeks),and the number of internal fistula was less in the simple internal fistula group than that of the ipsilateral group(1.27±0.59 times vs 2.03±0.84 times)(all P<0.05).The primary failure rate in the simple internal fistula group and the contralateral group were lower than that of the ipsilateral group.The one-year patency rate was higher,while the incidence of dysfunction and complications were lower in the simple internal fistula group than those of the ipsilateral group(all P<0.05).Body mass index<21 kg/m^(2),diabetes mellitus,hyperphosphatemia,internal fistula ipsilateral to central venous catheterization and infection were risk factors for MHD patients with arteriovenous fistula dysfunction(all P<0.05).Conclusion:Compared with the ipsilateral central venous catheterization,simple arteriovenous fistula has higher patency rate and lower incidence of complications.