90例维持性血液透析患者血管通路的使用情况分析  

Vascular access in 90 maintenance hemodialysis patients

作　　者：马小玉[1] 王显友 丁广贵 赵靳 Ma Xiaoyu;Wang Xianyou;Ding Guanggui;Zhao Jin(Department of Hemodialysis,Mingguang People's Hospital,Mingguang 239400,Anhui,China;Department of General Surgery,Mingguang People's Hospital,Mingguang 239400,Anhui,China;Department of Nephrology,Mingguang People's Hospital,Mingguang 239400,Anhui,China)

机构地区：[1]明光市人民医院血透室,安徽明光239400 [2]明光市人民医院普外科,安徽明光239400 [3]明光市人民医院肾病学科,安徽明光239400

出　　处：《血管与腔内血管外科杂志》2023年第7期868-871,共4页Journal of Vascular and Endovascular Surgery

摘　　要：目的探讨维持性血液透析患者血管通路的使用情况。方法收集2020年2月至2022年8月于明光市人民医院接受血液透析治疗的90例患者的临床资料,按首次血液透析时使用血管通路的不同类型将其分为动静脉内瘘组(n=27)和临时静脉导管组(n=63),收集患者基本信息,分析维持血液透析患者血管通路使用情况及首次血液透析时患者血管通路使用情况的预测因素。结果动静脉内瘘组患者中男性比例、市区外患者比例均明显低于临时静脉导管组患者,肾小球滤过率明显高于临时静脉导管组患者,差异均有统计学意义(P﹤0.01)。多因素分析结果显示,男性、市区外患者、肾小球滤过率﹤5 ml/(min·1.73m^(2))均是首次血液透析时患者使用临时静脉导管的预测因素。90例维持血液透析患者中,83例血管通路使用动静脉内瘘,其中前臂内瘘75例、高位内瘘8例,并发症发生率为26.5%(22/83);7例使用带涤纶套导管,并发症并发症发生率为28.6%(2/7),两者并发症发生率比较,差异无统计学意义(P﹥0.05)。结论多数血液透析患者在长期维持治疗过程中的血管通路以动静脉内瘘为主,但在首次血液透析时大部分患者以临时静脉导管为主。临床中应尽早评估患者情况,尽快建立动静脉内瘘通路,从而更有利于患者的维持性血液透析治疗效果。Objective To explore the use of vascular access in maintenance hemodialysis patients.Method Clinical data of 90 patients who received hemodialysis in the Mingguang People's Hospital from February 2020 to August 2022 were collected.According to the type of access used in the first dialysis,the patients were divided into arteriovenous fistula group(n=27)and temporary venous catheter group(n=63).The basic information of patients was collected,the predictors of the use of vascular access in maintenance hemodialysis patients and in the first hemodialysis patients were analyzed.Result The ratio of male patients and patients outside the urban area in the arteriovenous fistula group were significantly lower,and glomerular filtration rate significantly higher than those in the temporary venous catheter group,the differences were statistically significant(P<0.01).Multivariate analysis showed that,men,patients outside the urban area and glomerular filtration rate<5 ml/(min·1.73m^(2))were predictive factors for the use of temporary venous catheters in the first dialysis.In the 90 cases of maintenance dialysis,83 cases were arteriovenous fistula,including 75 cases of forearm fistula and 8 cases of high internal fistula,with the complication rate of 26.5%(22/83),7 cases were catheter with polyester fiber sleeve,with the complication rate of 28.6%(2/7),there was no significant difference for the incidence of complication(P>0.05).Conclusion Arteriovenous fistula is mainly used during maintenance hemodialysis in most patients,but the temporary venous catheters are mainly used in the first dialysis.In clinical practice,patients should be evaluated as early as possible and arteriovenous fistula access should be established as early as possible,which is more conducive to the maintenance hemodialysis treatment effect of patients.

关 键 词：血液透析 血管通路 动静脉内瘘 临时静脉导管 

分 类 号：R543[医药卫生—心血管疾病]