中国医师进修杂志
中國醫師進脩雜誌
중국의사진수잡지
CHINESE JOURNAL OF POSTGRADUATES OF MEDICINE
2010年
18期
11-14
,共4页
弓伟%范静东%佟峰%叶朝阳
弓偉%範靜東%佟峰%葉朝暘
궁위%범정동%동봉%협조양
导管,留置%动静脉瘘%肾透析
導管,留置%動靜脈瘺%腎透析
도관,류치%동정맥루%신투석
Catheters,indwelling%Arteriovenous fistula%Renal dialysis
目的 对长期留置导管与动静脉内瘘行长期血液透析患者生存质量评估进行对比观察.方法 选择血管通路为动静脉内瘘(内瘘组)和长期留置导管(导管组)患者各30例,记录两组血管通路感染率、血栓率、血流量;检测透析前后血尿素氮、肌酐、电解质、血红蛋白、C反应蛋白、甲状旁腺激素、β2微球蛋白;行主观综合营养评价(SGA);计算尿素清除指数(KT/V)、尿素下降率(URR);使用KDQOL-SFTM量表评估患者的生存质量,调查患者住院情况,并进行对比分析.结果 内瘘组和导管组KT/V分别为1.49±0.25、1.45±0.28,差异无统计学意义;两组实验室检查及SGA评分差异无统计学意义;两组患者在肾脏病对日常生活的影响、肾脏病给生活带来的负担、工作状况、认知功能、社交质量、体能、总体健康、情感等生存质量方面比较差异无统计学意义,而在疼痛方面导管组得分明显高于内瘘组(P＜0.05),两组住院情况比较差异无统计学意义;导管组感染率明显高于内瘘组(P＜0.05),两组血栓发生率比较差异无统计学意义.结论 长期留置导管作为无法建立内瘘患者的替代通路,能够满足血液透析和患者生存质量的需要,在减少患者疼痛方面更有优势,感染、血栓等并发症的发生率较以前显著下降,但仍是需要解决的重点问题.
目的 對長期留置導管與動靜脈內瘺行長期血液透析患者生存質量評估進行對比觀察.方法 選擇血管通路為動靜脈內瘺(內瘺組)和長期留置導管(導管組)患者各30例,記錄兩組血管通路感染率、血栓率、血流量;檢測透析前後血尿素氮、肌酐、電解質、血紅蛋白、C反應蛋白、甲狀徬腺激素、β2微毬蛋白;行主觀綜閤營養評價(SGA);計算尿素清除指數(KT/V)、尿素下降率(URR);使用KDQOL-SFTM量錶評估患者的生存質量,調查患者住院情況,併進行對比分析.結果 內瘺組和導管組KT/V分彆為1.49±0.25、1.45±0.28,差異無統計學意義;兩組實驗室檢查及SGA評分差異無統計學意義;兩組患者在腎髒病對日常生活的影響、腎髒病給生活帶來的負擔、工作狀況、認知功能、社交質量、體能、總體健康、情感等生存質量方麵比較差異無統計學意義,而在疼痛方麵導管組得分明顯高于內瘺組(P＜0.05),兩組住院情況比較差異無統計學意義;導管組感染率明顯高于內瘺組(P＜0.05),兩組血栓髮生率比較差異無統計學意義.結論 長期留置導管作為無法建立內瘺患者的替代通路,能夠滿足血液透析和患者生存質量的需要,在減少患者疼痛方麵更有優勢,感染、血栓等併髮癥的髮生率較以前顯著下降,但仍是需要解決的重點問題.
목적 대장기류치도관여동정맥내루행장기혈액투석환자생존질량평고진행대비관찰.방법 선택혈관통로위동정맥내루(내루조)화장기류치도관(도관조)환자각30례,기록량조혈관통로감염솔、혈전솔、혈류량;검측투석전후혈뇨소담、기항、전해질、혈홍단백、C반응단백、갑상방선격소、β2미구단백;행주관종합영양평개(SGA);계산뇨소청제지수(KT/V)、뇨소하강솔(URR);사용KDQOL-SFTM량표평고환자적생존질량,조사환자주원정황,병진행대비분석.결과 내루조화도관조KT/V분별위1.49±0.25、1.45±0.28,차이무통계학의의;량조실험실검사급SGA평분차이무통계학의의;량조환자재신장병대일상생활적영향、신장병급생활대래적부담、공작상황、인지공능、사교질량、체능、총체건강、정감등생존질량방면비교차이무통계학의의,이재동통방면도관조득분명현고우내루조(P＜0.05),량조주원정황비교차이무통계학의의;도관조감염솔명현고우내루조(P＜0.05),량조혈전발생솔비교차이무통계학의의.결론 장기류치도관작위무법건립내루환자적체대통로,능구만족혈액투석화환자생존질량적수요,재감소환자동통방면경유우세,감염、혈전등병발증적발생솔교이전현저하강,단잉시수요해결적중점문제.
Abstract Objective To compare the quality of life in long-term hemodialysis patients using tunnel cuffed catheter with arterio-venous fistula. Methods Thirty patients using tunnel cuffed catheter (catheter group) and another 30 patients using arterio-venous fistula (fistula group) were observed. The rate of infection,thrombus and blood flow were recorded. The lab examinations such as blood urea nitrogen,creatinine,serum electrolyte,hemoglobin, C reactive protein, parathyrine, β2 microglobulin were measured,subjective global assessment (SGA) was made, KT/V and urea reduction ratio (URR) were calculated.Quality of life was surveyed with KDQOL-SFTM questionnaire and to conduct comparative analysis. Results KT/V was 1.49 ± 0.25 in catheter group, and 1.45 ± 0.28 in fistula group, there was no significant difference between the two groups. The lab examinations and SGA were similar in two groups. There were no significant difference of quality of life between the two groups except for pain (the score in catheter group was significantly higher than that in fistula group). The rate of infection was significantly higher in catheter group than that in fistula group. The rate of thrombus was similar in two groups. Conclusions As alternative of fistula in patients whose fistula could not be established, the tunnel cuffed catheter could give adequate dialysis and satisfactory quality of life,and is predominating in pain-reducing. The rates of infection and thrombus are decreased, but maintain the important problems to be solved.
