上海市单中心血液透析患者血管通路调查分析  

Vascular access investigation in a hemodialysis center in Shanghai

作　　者：程烨[1] 林曰勇[1] 叶朝阳[1] 戎殳[1] 陈静[1] 梅长林[1] 

机构地区：[1]第二军医大学附属长征医院肾内科,上海200003

出　　处：《中国血液净化》2011年第10期538-541,共4页Chinese Journal of Blood Purification

摘　　要：目的回顾性分析血液透析患者血管通路使用情况。方法记录第二军医大学附属长征医院自2010年1月1日至12月31日新进入血液透析患者与长期维持性血液透析患者的基本资料和不同血管通路的选择概况,并对维持性血液透析患者中自体动静脉内瘘(arteriovenous fistula,AVF)使用和长期导管插管手术患者原发病种类进行统计分析。结果全年血液透析患者共1102例。其中新入血液透析患者667例(60.53%),维持性血液透析患者435例(39.47%),94.94%患者每周透析3次。667例新入透析患者分别选择临时导管81.26%、长期导管4.20%、AVF14.54%。435例维持透析患者分别选择临时导管1.84%、长期导管13.56%、AVF83.91%、人造血管0.69%。中心共施行AVF手术504例次、长期导管74例次和临时导管301例次:AVF手术中71.83%患者首选左前臂;选择右颈内静脉在长期导管和临时导管中分别为48.65%和87.04%。内瘘选择吻合血管依次为桡动脉-头静脉75.40%,肱动脉-正中静脉16.87%,肱动脉-贵要静脉2.98%,桡动脉-贵要静脉2.38%,肱动脉-头静脉2.38%。瘘管吻合方式主要为端端吻合52.60%,端侧吻合36.44%,侧侧吻合10.96%。收治患者AVF发生并发症173例,占总透析人数的15.7%,血栓125例占并发症总例数72.25%,其余依次为缺血14.45%,狭窄8.67%,肿胀手4.62%。长期导管年平均感染率为0.07次/1000导管日。结论新入透析患者中选择临时导管比例较大,说明国内患者大多数仍然不能提前准备瘘管。而维持性血液透析患者则绝大多数选择AVF,聚四氟乙烯(poly tetra fluoro ethylene,PTFE)人造血管相对偏少,留置长期导管后许多患者由于方便性不愿进一步手术。减少内瘘并发症依然是临床工作者的研究目标和方向。Objective To retrospectively investigate vascular access （VA） in hemodialysis patients in our hemodialysis center. Method We recruited 1102 patients in this center in 2010, of whom 667 were incident patients, and 435 were prevalent patients. Their VA types were recorded. Autologous arteriovenous fistula （AVF） used in maintenance hemodialysis patients and the primary diseases in patients with long-term indwelling catheterization were analyzed. SPSS software was used for the statistical analyses. Results In the 667 incident patients for VA, 81.26% of them used provisional catheter, 4.2% long-term cuffed catheter, and 14.54% AVF. In the 435 prevalent patients, 83.91% of them used AVF, 13.56% long-term cuffed catheter, 1.84% provisional catheter, and 0.69% graft vessel. The radio-cephalic anastomosis was the most common site for AVF. We treated complications from AVF in 173 cases （15.7%）. The complications seen in these patients included thrombosis （72.25%）, arterial steal syndrome （14.45%）, stenosis at anastomosis site （8.67%）, and extremity edema （4.62%）. The average infection rate in patients with long-term cuffed catheters was 0.07/1,000 catheterization days. Conclusion In incident patients, provisional catheters were frequently performed. In maintenance hemodialysis patients, autologous AVF was frequently seen, and artificial vessel graft for VA was less recommended. Prevention of complications from AVF has been an important issue in clinical practice.

关 键 词：血管通路 动静脉内瘘 长期导管 并发症 

分 类 号：R318.16[医药卫生—生物医学工程]