不同透析用血管通路对老年维持性血液透析患者的影响  

Influence of different hemodialysis vascular access on elderly maintenance hemodialysis patients

作　　者：郭振 张盼盼[1] 任双双 Guo Zhen;Zhang Panpan;Ren Shuangshuang(Department of Blood Purification,The First Affiliated Hospital of Henan University of Science and Technology,Luoyang 471000,China)

机构地区：[1]河南科技大学第一附属医院血液净化科,洛阳471000

出　　处：《国际移植与血液净化杂志》2023年第3期5-8,共4页International Journal of Transplantation and Hemopurification

摘　　要：目的探讨不同透析用血管通路对老年维持性血液透析患者的影响。方法回顾性分析2020年4月至2022年6月期间于河南科技大学第一附属医院血液净化科接受维持性血液透析治疗的103例老年患者作为研究对象,按透析用血管通路分为导管组和内瘘组,导管组51例给予深静脉导管留置,内瘘组52例给予自体动静脉内瘘,比较两组透析效能、炎症因子水平以及心功能。结果内瘘组尿素氮下降率、尿素氮清除率以及血管通路血流量均高于导管组(P<0.05)。置管前两组患者超敏C反应蛋白(high-sensitivity C-reactive protein,hs-CRP)、β2-微球蛋白(β2-microglobulin,β2-MG)、白细胞介素-6(interleukin-6,IL-6)、肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)表达水平差异无统计学意义(P>0.05),置管后两组患者hs-CRP、β2-MG、IL-6以及TNF-α表达水平均下降且内瘘组低于导管组(P<0.05)。置管前两组患者室间隔舒张末期厚度(intel-ventricular scptum end-diastolic thickness,IVSTD)、左心室舒张末期内径(left ventricular end-diastolic dimension,LVEDD)、左室后壁舒张末期厚度(left ventricular posterior wall thickness at end-diastole,LVPWTD)、射血分数(ejection fraction,EF)、舒张早期和舒张晚期左心房室瓣口最大血流速度比(E/A)差异无统计学意义(P>0.05),置管后两组患者IVSTD、LVEDD、LVPWTD、EF、E/A均发生改变,但两组间差异无统计学意义(P>0.05)。结论在老年维持性血液透析患者中以自体动静脉内瘘为血管通络可更好地提高透析效能,降低机体炎症水平且不影响心功能。Objective To explore the influence of different dialysis vascular access on elderly maintenance hemodialysis patients.Methods A total of 103 elderly patients who received maintenance hemodialysis in our hospital from April 2020 to June 2022 were enrolled in this study.All the patients were divided into two groups according to the method of random number table.Fifty-one patients in the catheter group were given deep venous catheter indenture,and 52 patients in the internal fistula group were given autologous arteriovenous fistula.The dialysis efficacy,inflammatory factor levels and cardiac function of the two groups were compared.Results The urea nitrogen reduction rate,urea nitrogen clearance rate and blood flow through vascular access in the fistula group were higher than those in the catheter group(P<0.05).There was no significant difference in the expression levels of high-sensitivity C-reactive protein(hs-CRP),β2-microglobulin(β2-MG),interleukin-6(IL-6),tumor necrosis factor-α(TNF-α)between the two groups before catheterization(P>0.05),but the expression levels of hs-CRP,β2-MG,IL-6 and TNF-αwere decreased after catheterization,and the internal fistula group was lower than the catheter group(P<0.05).There was no significant difference in intel-ventricular scptum end-diastolic thickness(IVSTD),left ventricular end-diastolic dimension,(LVEDD),left ventricular posterior wall thickness at end-diastole(LVPWTD),ejection fraction(EF),E/A between the two groups before catheterization(P>0.05),and there was no significant difference in IVSTD,LVEDD,LVPWTD,EF,E/A between the two groups after catheterization(P>0.05).Conclusion In elderly patients with maintenance hemodialysis,autologous arteriovenous fistula can improve the efficiency of dialysis,reduce the level of inflammation and do not affect cardiac function.

关 键 词：维持性血液透析 透析效能 心功能 炎症水平 血管通络 

分 类 号：R459.5[医药卫生—治疗学]