不同血管通路在血液透析患者中的应用效果  

Application effect of different vascular access in hemodialysis patients

作　　者：潘金英[1] 陈友明[1] 郑露莉 田洁[1] 曾艳[1] PAN Jin-ying;Chen You-ming;ZHENG Lu-li;TIAN Jie;ZENG Yan(Department of Hemopurification,Fujian Provincial Hospital,Fuzhou 350001,China)

机构地区：[1]福建省立医院血液净化科

出　　处：《中国当代医药》2019年第28期94-97,共4页China Modern Medicine

摘　　要：目的探讨不同血管通路在血液透析(HD)患者中的应用效果。方法回顾性分析2017年6月~2018年6月我院收治的77例维持性血液透析(MHD)患者的临床资料,按血管通路不同分为内瘘组(n=50例)和导管组(n=27例)。内瘘组采用自体动静脉内瘘(AVF)行HD治疗,导管组采用永久性皮下隧道带涤纶套导管(CTC)行透析治疗。比较两组治疗前后的血清铁(Fe)、铁蛋白(Fr)、血红蛋白(Hb)、钙(Ca)、磷(P)、甲状旁腺素(PTH)、尿素氮(BUN)、肌酐(Cr)、β2-微球蛋白(β2-MG)、C-反应蛋白(CRP)、白介素-6(IL-6)及并发症发生率。结果两组治疗1年后的Fe、Fr、Hb、Ca、P、PTH、BUN、Cr、β2-MG水平比较,差异无统计学意义(P>0.05)。治疗前,两组的CRP和IL-6水平比较,差异无统计学意义(P>0.05);内瘘组治疗后的CRP和IL-6水平明显低于导管组,差异有统计学意义(P<0.05)。内瘘组的感染及栓塞发生率明显低于导管组,差异有统计学意义(P<0.05)。结论AVF较中心导管能减轻患者微炎症状态,减少并发症的发生,是HD患者首选的血管通路。Objective To investigate the effect of different vascular access in hemodialysis (HD) patients. Methods The clinical data of 77 maintenance hemodialysis (MHD) patients treated in our hospital from June 2017 to June 2018 were retrospectively analyzed. According to different vascular access, the patients were divided into internal fistula group (n=50) and catheter group (n=27). The patients in internal fistula group were received hemodialysis treatment by arteriovenous internal fistula (AVF). The patients in catheter group were received dialysis treatment by central venous catheter (CTC). Serum iron (Fe), ferritin (Fr), hemoglobin (Hb), calcium (Ca), phosphorus (P), parathyroid hormone (PTH), urea nitrogen (BUN), creatinine (Cr),β2-microglobulin (β2-MG), C-reactive protein (CRP), interleukin-6 (IL-6) and the incidence of complications were compared between the two groups before and after treatment. Results There were no statistically significant differences in the levels of Fe, Fr, Hb, Ca, P, PTH, BUN, Cr,β2-MG after 1 year of treatment between the two groups. Before treatment, there were no statistically significant difference in CRP and IL-6 levels between the two groups (P>0.05). After treatment, CRP and IL-6 levels in the fistula group were significantly lower than those in the catheter group (P<0.05). The incidence of infection and embolism in the internal fistula group were significantly lower than those in the catheter group, and the differences were statistically significant (P<0.05). Conclusion AVF can reduce the micro-inflammatory state of patients, reduce the incidence of complications, and is the preferred vascular access for HD patients.

关 键 词：血管通路 动静脉内瘘 中心静脉导管 

分 类 号：R692.5[医药卫生—泌尿科学]