蚌埠地区老年维持性血液透析患者血管通路调查分析  

Investigation of vascular access status in elderly maintenance hemodialysis patients in Bengbu area

作　　者：黄玉萍[1] 徐辉 王道洋[1] 周玉叶[1] 吴雪平[3] 王德光[4] HUANG Yu-ping;XU Hui;WANG Dao-yang;ZHOU Yu-ye;WU Xue-ping;WANG De-guang(Department of Nephrology,The Second Affiliated Hospital of Bengbu Medical College,Bengbu 233040,China;Department of Nephrology,The Traditional Chinese Medicine Hospital of Huaiyuan county,Huaiyuan 233400,China;Department of Nephrology,The First Affiliated Hospital of Bengbu Medical College,Bengbu 233000,China;Department of Nephrology,The Second Hospital of Anhui Medical University,Hefei 230601,China)

机构地区：[1]蚌埠医学院第二附属医院肾脏内科,蚌埠233040 [2]怀远县中医院肾脏内科,怀远233400 [3]蚌埠医学院第一附属医院肾脏内科,蚌埠233000 [4]安徽医科大学第二附属医院肾脏内科,合肥230601

出　　处：《中国血液净化》2021年第12期835-838,共4页Chinese Journal of Blood Purification

基　　金：蚌埠医学院自然科学类项目(BYKF18119)。

摘　　要：目的分析蚌埠地区老年维持性血液透析(maintenance hemodialysis,MHD)患者的血管通路的情况。方法纳入130例年龄≥60岁的MHD患者作为老年组,162例年龄<60岁的MHD患者作为非老年组。对老年组和非老年组患者首次透析及维持透析血管通路的分布情况进行比较;并对老年MHD患者动静脉内瘘组及导管组临床资料进行分析。结果蚌埠地区老年MHD患者血管通路分布中,自体动静脉内瘘(arteriovenous fistula,AVF)占比62.3%,移植物内瘘(arteriovenous graft,AVG)占比0.8%,带隧道带涤纶套导管(tunneled cuffed catheter,TCC)占比36.9%。老年组和非老年组患者首次透析使用临时导管的比例较高;老年组首次透析使用临时导管的比例明显高于非老年组(χ^(2)=18.945,P<0.001),非老年组首次透析使用AVF比例高于老年组(χ^(2)=17.505,P<0.001)。MHD血管通路方面老年组TCC使用率高于非老年组(χ^(2)=27.930,P<0.001)。老年MHD患者AVF组血红蛋白(t=-7.712,P<0.001)及白蛋白(t=-6.323,P<0.001)明显高于TCC组;AVF组糖尿病比例(t=14.857,P<0.001)、hsCRP(t=-3.172,P=0.002)及血肌酐(t=4.626,P=0.033)明显低TCC组。结论蚌埠地区老年MHD患者血管通路构成不太理想,距我国血管通路专家共识推荐的目标还有一定的差距。患者初次血液透析及MHD的动静脉内瘘使用率较低。MHD患者采用AVF通路透析对体内微炎症状态、营养状况及贫血影响较小。临床应将AVF作为透析患者血管通路的“首要选择”,在此基础之上兼顾“个体化”选择。Objective To investigate the vascular access situation in elderly maintenance hemodialysis(MHD)patients in Bengbu area.Methods A total of 130 MHD patients over 60 years old were enrolled as the elderly group,and a total of 162 MHD patients less than 60 years old were recruited as the non-elderly group.The distribution of vascular access methods at the beginning of hemodialysis and during MHD period were compared between the two groups.Clinical data in elderly group were compared between the patients using internal fistulas and those using venous catheters.Results Of the vascular access methods in elderly group,arteriovenous fistula(AVF)accounted for 62.3%,arteriovenous graft(AVG)for 0.8%,and tunneled cuffed catheter(TCC)for 36.9%.The proportion of using provisional venous catheter as vascular access at first was relatively high in both elderly group and non-elderly group,and was higher in elderly group than in non-elderly group(χ^(2)=18.945,P<0.001).The proportion of using AVF as vascular access at first was higher in non-elderly group than in elderly group(χ^(2)=17.505,P<0.001).The proportion of using TCC as vascular access was higher in elderly group than in non-elderly(χ^(2)=27.930,P<0.001).In elderly group,the concentrations of hemoglobin and albumin were higher in the patients with AVF than those with TCC(t=-7.712 and-6.323 respectively;P<0.001);the ratio of diabetes and the concentrations of serum hsCRP and creatinine were lower in the patients with AVF than those with TCC(t=14.857,-3.172 and 4.626 respectively,P<0.001,P=0.002 and P=0.033 respectively).Conclusion The constituents of vascular access methods for elderly MHD patients in Bengbu area were unsatisfactory to the targets recommended by the Expert Consensus on Vascular Access in China.The proportion of using AVF at the beginning of hemodialysis and during MHD was lower,while this vascular access method has less effects on microinflammatory state,nutritional status and anemia of the patients.Therefore,AVF should be adopted as the first choice of v

关 键 词：血液透析 老年 血管通路 动静脉内瘘 

分 类 号：R318.16[医药卫生—生物医学工程]