CAJ | 학술논문

目的调查天津市维持性血液透析(maintenance hemodialysis,MHD)患者不同血管通路的应用及主要并发症发生率.方法选取在天津市三级甲等医院行MHD治疗的患者为调查对象,收集患者一般情况、透析龄、血管通路类型和使用时间、并发症及出现时间等资料.共采集到2651份有效病例,依据血管通路的不同分为动静脉内瘘组和隧道型导管组,分析两组患者的临床资料及主要并发症的特征.结果 MHD患者中自体动静脉血管内瘘使用率最高[2047例(77.22％)],带Cuff的隧道型半永久中心静脉导管(隧道型导管)为559例(22.59％),移植血管的使用率较低[5例(0.19％)].首次透析通路使用不带Cuff非隧道型临时中心静脉导管(临时导管)比例较高[2484例(93.70％)].相比动静脉内瘘组,隧道型导管组前4年的血栓形成、感染等并发症发生率较高(P=0.003).结论自体动静脉内瘘仍是MHD患者的首要选择,使用的比例较高,隧道型导管次之.首次透析使用临时静脉导管比例较高,需加强慢性肾功能不全后期的管理,适时建立长期透析通路.
목적 조사천진시유지성혈액투석(maintenance hemodialysis,MHD)환자불동혈관통로적응용급주요병발증발생솔.방법 선취재천진시삼급갑등의원행MHD치료적환자위조사대상,수집환자일반정황、투석령、혈관통로류형화사용시간、병발증급출현시간등자료.공채집도2651빈유효병례,의거혈관통로적불동분위동정맥내루조화수도형도관조,분석량조환자적림상자료급주요병발증적특정.결과 MHD환자중자체동정맥혈관내루사용솔최고[2047례(77.22％)],대Cuff적수도형반영구중심정맥도관(수도형도관)위559례(22.59％),이식혈관적사용솔교저[5례(0.19％)].수차투석통로사용불대Cuff비수도형림시중심정맥도관(림시도관)비례교고[2484례(93.70％)].상비동정맥내루조,수도형도관조전4년적혈전형성、감염등병발증발생솔교고(P=0.003).결론 자체동정맥내루잉시MHD환자적수요선택,사용적비례교고,수도형도관차지.수차투석사용림시정맥도관비례교고,수가강만성신공능불전후기적관리,괄시건립장기투석통로.
Objective To investigate the use of vascular access and complication incidence in patients undergoing maintenance hemodialysis in Tianjin.Methods Patients undergoing maintenance hemodialysis in the third level of first-class hospital in Tianjin were investigated.The investigate method was live interview.Two thousand six hundred and fifty-one cases were available.Basic data,age of dialysis,type of vascular access,age of vascular access and complications were recorded.The differences in clinic data and complications between patients using arteriovenous fistulas (AVF) and central venous catheter (CVC) as vascular access were compared.Results There were 2047 (77.22％) patients using AVF as vascular access,559 (22.59％) patients using tunnel type central venous catheter,and 5 (0.19％) patients using arteriovenous graft (AVG) for maintenance hemodialysis.Most patients used temporary catheter as the first vascular access [2484(93.70％)].Compared to AVF,CVC had high incidence of thrombosis and infection in the first four years (P=0.003).Conclusions AVF remains the first choice for maintenance hemodialysis.Most patients use AVF as their vascular access.The second preferred choice is CVC.The management of late chronic kidney disease should be enhanced to avoid the high usage of temporary catheter.