永久性深静脉置管对血液透析患者营养状态及透析效果的影响  

The Clinical Study on Nutritional Status and Dialysis Effect of Long-term Cuffed Catheter in Hemodialysis Patients

作　　者：陈莉[1] 刘毅[1] 郑尘非[1] 孙文学[1] 徐玉兰[1] 

机构地区：[1]温州医学院附属第一医院血液净化中心,温州325000

出　　处：《中国中西医结合肾病杂志》2007年第8期462-465,共4页Chinese Journal of Integrated Traditional and Western Nephrology

摘　　要：目的:探讨永久性深静脉置管与动静脉内瘘患者在营养状态、透析效果及并发症的差异。方法:对64例维持性血液透析的尿毒症患者,其中永久性深静脉置管21例,动静脉内瘘患者43例的营养、透析效果指标,以及近3个月内并发症发生情况进行分析。结果:永久性深静脉置管患者与动静脉内瘘患者相比,血红蛋白(Hb),血浆白蛋白(Alb),总蛋白(TP),总胆固醇(TC),甘油三酯(TG),高密度脂蛋白(HDL),低密度脂蛋白(LDL),C反应蛋白(CRP),钾(K+),钠(Na+),氯(Cl-),钙(Ca2+),磷(P3+),铁(Fe3+),透前透后BUN、Cr及UA,心胸比大小,KT/V,URR及PCR值无明显差异。永久性深静脉置管患者血流不畅的发生率高于动静脉内瘘患者(7.74%vs 0.64%,P<0.001),永久性深静脉置管患者导管相关性感染的发生率高于动静脉内瘘患者(1.43%vs 0.17%,P<0.001),永久性深静脉置管患者血栓栓塞的发生率与动静脉内瘘患者相比,无统计学差异。结论:对于内瘘难以建立的血液透析患者尤其是心功能差和/或血管条件差患者,永久性静脉置管是一种安全有效的血管通路方式。Objective： To investigate the difference in nutrition status and dialysis effect and complication associated with catheter between long - term cuffed catheter and arteriovenous fistula groups. Methods：64 long- term hemodialysis patients were enrolled in the study, 21 patients with long - term cuffed catheter, and 43 patients with arteriovenous fistula. Comparative study of nutritional status,dialysis effect and complications happened in the last three months between long- term cuffed catheter and arteriove nous fistula patients was conducted. The number of times in unsmeoth flow of blood and thromboemholism and infection associated with catheter of this two groups was recorded. Results： No significant difference was found in serum albumin, total protein, hemoglobin, total cholesterol, triglyceride, alpha-lipoprotein, low density lipoprotein, C reactive protein, K^＋ , Na^＋ , Cl^- , Ca^2＋, P^3 ＋, Fe^3- , BUN, Cr, UA before and after hemodialysis , Cardiothoracic ratio, KT/V, URR and PCR between long- term cuffed catheter and arteriovenous fistula groups. The frequency of unsmooth flow of blood incidence rate in patients with long- term cuffed cather was is higher than patients with arterriovenous fistula（7.74% vs 0.64% ,P〈0. 001）. the Infection incidence associated with catheter were significantly higher in the long - term cuffed catheter patients compared with arteriovenous fistula patients （ 1.43 % vs 0.17 %, P 〈 0. 001 ）. No significant difference was found in thromboemholism between long - term cuffed catheter and arteriovenous fistula groups. Conclusion：The long- term cuffed catheter is a perfect choice for those patients with difficulties in establishing arteriovenous fistula, especially for these with bad blood vessel condition and heart function.

关 键 词：永久性深静脉置管 动静脉内瘘 透析效果 营养状态 并发症 

分 类 号：R692.5[医药卫生—泌尿科学]