终末期肾病患者血管通路准备情况的调查与分析

Investigation and Analysis of Vascular Access Preparation in Patients with End-Stage Renal Disease

目的:了解终末期肾病患者进入透析时血管通路的情况,提供保护血管资源的临床依据和建议。方法:统计2009~2013年长沙五家三甲医院811例透析患者的一般资料、起始通路方式、初诊为慢性肾功能不全(CRF)到透析的时间、透析前有无被医生告知至少需3个月时间建立动静脉内瘘、临时导管留置时间及建立次数,将患者按进入透析时血管通路方式分为长期和临时通路组,分析可能的影响因素,并与国外资料相比较。结果:①78.67%的患者进入透析时无成熟的长期血管通路。患者性别、年龄、糖尿病肾病、高血压肾病与进入通路时血管通路类型无统计学关系。②长期通路建立前临时导管留置时间<7天者仅4.96%;临时导管建立1次者51.29%,≥2次者18.37%。③进入透析前被医生告知需提前建立内瘘且至少需3个月时间准备的患者仅占18.49%。④初诊为CRF到初次透析的时间>1年的患者占59%,与美国、欧洲、加拿大无明显差别;进入透析时临时导管的使用率明显高于美国、欧洲、加拿大。结论:大部分患者在确诊后有充足时间建立自体内瘘,但患者进入透析时临时导管的使用率高、使用频繁、留置时间过长,多数患者缺乏成熟的长期血管通路,医生透析前准备和宣教工作不到位是重要因素之一。

Objective To investigate the vascular access situation and provide clinical data and recommendations about protecting the blood vessels resources in patients with end-stage renal disease when staring dialysis. Methods 811 patients with maintenance hemodialysis treatment in five hospitals of Changsha were included in this study from 2009 to 2013,general information、vascular access methods in initial dialysis、the period between nephrologists diagnosed as chronic renal insufficiency( CRF) to the initial dialysis、doctors informed at least three months to establish arteriovenous fistula before dialysis、the catheterization times and the indwelling time of temporary catheter were collected and analyzed. The patients were divided into 2 groups according to vascular access situation: permanent group and temporary group. Compared to the data from abroad and analysis the possible factors. Results ①78. 67% of the patients haven't permanent vascular access in initial dialysis. Sex、age、diabetic nephropathy、hypertensive nephropathy was unrelated to the vascular access in initial dialysis. ②Temporary catheter indwelling time less than 7 days was only 4. 96%; the percentage of patients that temporary catheter placed 1 times was 51. 29%,≥ 2 times was 18. 37%. ③The patients who have been informed that it's necessary to take at least three months to establish arteriovenous fistula before dialysis was only 18. 49%. ④It was 59% of patients over 1 year since been diagnosed as CRF to the initial dialysis,which have no significant difference from the US、Europe、 Canada; while temporary catheter utilization was significantly higher than the US、Europe、Canada. Conclusion Most ESRD patients have sufficient time to establish a permanent vascular access,but during their dialysis,the temporary catheter usage rate was too high,too frequently and indwelling time was too long,most patients were lack of mature permanent vascular access,the shortage of doctor's preparations and instructions before dialysis is one of the most important factors.