上海市首次血液透析血管通路使用情况及相关因素分析  

Vascular access at the initiation of hemodialysis and its related factors in Shanghai

作　　者：任崇[1,2] 卢文文[1] 杨晓莉[3] 黄碧红[2] 韩新[1] 曹艳佩[3] 

机构地区：[1]上海市复旦大学附属华山医院护理部,上海200040 [2]复旦大学护理学院,上海200040 [3]上海市复旦大学附属华山医院肾内科,上海200040

出　　处：《中国血液净化》2016年第6期344-347,共4页Chinese Journal of Blood Purification

基　　金：上海市卫生和计划生育委员会科研课题基金项目(编号:201540085)

摘　　要：目的调查维持性血液透析患者首次透析血管通路的使用情况，分析影响通路选择的因素，为提高首次血液透析自体动静脉内瘘的使用率提供依据。方法选择2015年10月至2016年1月期间在复旦大学附属华山医院血液净化中心进行维持性血液透析的患者125例进行调查，描述本中心患者首次血液透析血管通路的使用情况，分析影响其首次血透血管通路选择的因素。结果首次血液透析即使用自体动静脉内瘘的占53．600％。插管组和内瘘组在合并高血压（24例比43例，x2=6．042，P=0．014）、诊断出肾病到开始透析的间期[1．085（0．000-42．280）年比4．170（0．170-40．112）年，Z=2．314，P=0．021）、首次透析前有肾脏专科随访（23例比53例，x2=19．496，P〈0．001）、医生首次建议建瘘到开始透析的问期方面[0．000（-36．505-13．201）月比4．100（1．000-75．072）月，Z=7．748，P〈0．001]有显著性差异。结论本中心患者首次血液透析即使用自体动静脉内瘘的比例虽然相对较高，但仍需提高。首次血液透析血管通路的选择与是否合并高血压、诊断肾病的早晚、肾科随访及医生建议建瘘的时机有关。Objective To investigate the vascular access modalities at the initiation of hemodialysis in maintenance hemodialysis （MHD） patients, and to analyze the factors affecting the selection of vascular access modalities. Methods A total of 125 MHD patients were recruited from Shanghai Huashan Hospital during the period from Oct. 1, 2015 to Jan. 1, 2016. The vascular access modalities at the initiation ofhemodialysis were described, and the factors relating to the selection of vascular access modalities were analyzed. Results Arteriovenous fistula was used at the initiation of hemodialysis in 53.6% MHD patients. There were significant differences in hypertension （24 vs. 43, x2=6.042, P=0.014）, time from diagnosis of renal disease to the initiation of hemodialysis [1.085（0.000-42.280） vs. 4.170 （0.170-40.112） years, Z=2.314, P=0.021], referral to nephrologists before the initiation of hemodialysis （23 vs. 53, x2=19.496, P〈0.001）, and period from suggestion of arteriovenous fistula operation by nephrologists to the initiation of hemodialysis [0.000 （- 36.505-13.201） vs. 4.100 （1.000-75.072） months, Z=7.748, P〈0.001] between the patients using central venous catheter and those using arteriovenous fistula. Conclusions The proportion of arteriovenous fistula for blood access at the initiation of hemodialysis was higher in this Blood Purification Center, but needs to be increased further. The selection of blood access modality at the initiation of hemodialysis was related to hypertension, time from diagnosis of renal disease to the initiation of hemodialysis, referral to nephrologists before the initiation of hemodialysis, and period from suggestion of arteriovenous fistula operation by nephrologists to the initiation ofhemodialysis.

关 键 词：血液透析 血管通路 自体动静脉内瘘 

分 类 号：R318.16[医药卫生—生物医学工程]