CAJ | 학술논문

目的通过对不同血管通路血液透析患者透析充分性评估及并发症发生率的比较,探讨维持性血液透析患者理想的血管通路.方法选择上海交通大学医学院附属瑞金医院肾内科2006年1月至2008年3月间经新建立的长期血管通路行血液透析的患者,随访12～38月,评估以自体动静脉内瘘(AVF)、聚叫氟乙烯(PTFE)移植血管和颈内静脉带袖套隧道导管(CTC)为血管通路的血液透析患者的Kt/V值,比较三种长期血管通路的并发症的发生率.结果 98例维持性血液透析患者中,经AVF透析的患者68例;经PTFE移植血管透析的患者12例;经颈内静脉CTC透析的患者18例.AVF患者的年龄及感染的并发症较PTFE移植血管和CTC组低(P<0.01);AVF患者栓塞的发生率较PTFE移植血管低(P<0.01);CTC组患者在随访期间虽未发生栓寒并发症,但3例患者血流量不足;三种血管通路透析患者的Kt/V值大都>1,2,以AVF为最高(与CTC相比P<0.01).结论经AVF透析患者的年龄较轻、栓塞和感染的发生率较低;AVF应是长期血管通路的首选,在AVF无法建立时,PTFE移植血管和CTC仍可作为较好的长期血液透析通路,均能达到较好的透析效果.
목적 통과대불동혈관통로혈액투석환자투석충분성평고급병발증발생솔적비교,탐토유지성혈액투석환자이상적혈관통로.방법 선택상해교통대학의학원부속서금의원신내과2006년1월지2008년3월간경신건립적장기혈관통로행혈액투석적환자,수방12～38월,평고이자체동정맥내루(AVF)、취규불을희(PTFE)이식혈관화경내정맥대수투수도도관(CTC)위혈관통로적혈액투석환자적Kt/V치,비교삼충장기혈관통로적병발증적발생솔.결과 98례유지성혈액투석환자중,경AVF투석적환자68례;경PTFE이식혈관투석적환자12례;경경내정맥CTC투석적환자18례.AVF환자적년령급감염적병발증교PTFE이식혈관화CTC조저(P<0.01);AVF환자전새적발생솔교PTFE이식혈관저(P<0.01);CTC조환자재수방기간수미발생전한병발증,단3례환자혈류량불족;삼충혈관통로투석환자적Kt/V치대도>1,2,이AVF위최고(여CTC상비P<0.01).결론 경AVF투석환자적년령교경、전새화감염적발생솔교저;AVF응시장기혈관통로적수선,재AVF무법건립시,PTFE이식혈관화CTC잉가작위교호적장기혈액투석통로,균능체도교호적투석효과.
Objective To compare the dialysis adequacy and complications in hemodialysis patients with different vascular access, and try to find out an ideal vascular access approach. Methods Patients who underwent an operation of long-term bemodialysis access between Jan. 2006 and Mar. 2008 were enrolled in this study. Kt/V value and the morbidity of acccss-related complications were evaluated and compared in a follow-up period of 12～38 months among patients using vascular access of native artcriovcnous fistula (AVF), polytetrafluoroethylene (PTFE) grafts, and cuffed and tunneled catheter (CTC) in an internal jugular vein. Results In the 98 maintenance hemodialysis patients, 68 cases used native AVE 12 used PTFE grafts, and 18 cases used CTC as the long-term vascular access for hemodialysis. Patients accepted hcmodialysis by native AVF were younger and had lower infection rate, compared with those used PTFE grafts and CTC as the vascular access (P<0.01). Thrombosis formation was less in patients with native AVF than in those with FIFE grafts (P<0.01). In patients with CTC, no access thrombosis was found, but inadequate access flow presented in 3 cases. Kt/V value was more than 1.2 in all patients, but was highest in native AVF group (P <0.01, as compared with that in CTC group). Conclusion Patients using native AVF for vascular access for hemodialysis were younger, and had lower rate of thrombosis and infection. Therefore, native AVF is preferable for long-term vascular access. When this type of vascular access is difficult to be established, PTFE grafts or CTC can also be chosen with relatively satisfactory effect of dialysis.