终末期肾病患者首次血液透析血管通路应用状况的单中心研究  

The application status of vascular access at initiation of hemodialysis in patients with end stage renal disease-a single center study

作　　者：周参新[1] 蒋华[2] 张萍[2] 陈江华[2] 

机构地区：[1]宁波大学医学院附属鄞州医院肾内科 [2]浙江大学医学院附属第一医院肾脏病中心浙江省肾脏病防治技术研究重点实验室,杭州310003

出　　处：《中华肾脏病杂志》2014年第12期897-902,共6页Chinese Journal of Nephrology

基　　金：十二五国家科技支撑计划（2011BA110B07）;浙江省医药卫生科技计划（2011RCB020）

摘　　要：目的：调查终末期肾病（ESRD）患者接受首次血液透析（HD）时血管通路的使用情况，以及各类血管通路的转归，为推进有计划地建立透析通路的事业提供依据。方法调查2009年1月至2011年12月在浙江大学医学院附属第一医院肾脏病中心进行首次HD的ESRD患者，统计他们在首次HD时使用的血管通路种类，并对各类透析通路的转归和替代治疗的方式转换做进一步分析。结果观察期内共836例首次HD的ESRD患者，其中男性510例，女性326例，平均年龄（49.77±17.65）岁。首位基础疾病为原发性肾小球疾病（72.73%），其次为糖尿病肾病（11.60%）和高血压肾小动脉硬化（3.95%）。首次HD时仅有73例（8.73%）患者使用动静脉内瘘（arteriovenous fistula，AVF），763例（91.27%）患者使用中心静脉导管。在开始透析后半年内有535例（81.5%）患者使用AVF，123例（18.5%）患者使用带袖套导管，54例患者接受了肾移植、55例患者转为腹膜透析。logistic回归分析提示男性、来自杭州市以外地区的患者以及开始HD时患者GFR小于5 ml·min-1·（1.73 m2）-1均为首次HD时使用中心静脉导管的危险因素。结论 ESRD患者在开始HD时使用AVF的比例较低，但经过我们的努力大多数患者最终使用AVF作为维持性HD的长期血管通路。提高计划性通路建立的比例，增加开始HD时AVF的使用比例，仍是我们目前努力的方向和目标。Objective To investigate the types and outcome of vascular access in patients with end stage renal disease （ESRD） initiated hemodialysis （HD）, and provide the basis for advancing the proportion of planned HD with arteriovenous fistula （AVF）. Methods Clinical data, vascular access types at the initiation of HD, the outcomes of all types of dialysis access and the conversion of renal replacement therapy of ESRD patients who initiated HD in the first affiliated hospital of zhejiang university between January 2009 and December 2011 were retrospectively studied. Results A total of 836 patients were included in our study. Among them 510 were males and 326 were females. The average age was （49.77 ± 17.65） years old. The major primary diseases were primary glomerular disease （72.73%）, diabetic nephropathy （11.60%）and hypertensive nephrosclerosis （3.95%）. Only 73 patients （8.73%） used AVF as the vascular access at the initiation of HD, another 763 patients （91.27%） used central venous catheter. Six months after the start of dialysis, 542 patients （81.5%） had used AVF as permanent vascular access, 123 patients （18.5%）had used the tunneled cuffed catheter, 54 patients had received a transplant and 55 patients had converted to peritoneal dialysis. The results of logistic regression analysis suggested that being male, patients from outside hangzhou and patients whose glomerular filtration rate were lower than 5 ml·min-1·（1.73 m2）-1 were the risk factors of using central venous catheters at the initiation of HD. Conclusions Only a minority of patients used AVF at the initiation of HD, but most of the other patients switched to AVF within the following six months. Increasing the proportion of AVF as the vascular access of planned HD is still our current goal.

关 键 词：肾功能衰竭 慢性 血液透析 导管 留置 动静脉分流术 

分 类 号：R692.5[医药卫生—泌尿科学]