摘要
目的调查分析首次接受血液透析的终末期肾病(end stage renal disease,ESRD)患者的血管通路应用情况,为患者有计划地选择合适的血管通路提供依据。方法调查2011年10月至2013年12月在云南省曲靖市第二人民医院肾内科登记进行血液透析的患者,统计其在首次进行血液透析时选择血管通路的类型,随访6个月,分析患者血管通路的转归和治疗方案的变更。结果调查365例首次进行血液透析的ESRD患者,其中男225例,女140例;平均年龄(51.65±18.45)岁。大多数患者的基础发病原因是原发性肾小球疾病,比例为71.23%,其次为糖尿病肾病为10.96%。患者首次进行血液透析治疗时,大部分患者(84.93%)选择中心静脉导管(central venous catheter,CVC),只有少数(15.07%)患者选择动静脉内瘘(arteriovenous fistula,AVF)作为透析血管。但是,在随访6个月时间内,接受随访的340例患者中,选择AVF的患者245例(72.06%),接受肾移植21例(6.17%),转为腹膜透析28例(8.24%)。男性、来自曲靖市以外地区的患者以及首次进行血液透析时患者肾小球滤过率(glomerular filtration rate,GFR)小于5 ml·min^(-1)·(1.73 m^2)^(-1),这3个因素为患者首次进行血液透析时,选择中心静脉导管的危险因素。结论 ESRD患者在首次进行血液透析时,选择AVF的概率比较低,经过院方和患者及其家属的配合,大多数患者最后选择AVF作为透析通路,以保证血液透析的持续进行。
Objective To investigate the application status of vascular access in patients with end stage renal disease（ ESRD） in first time hemodialysis（ HD） in order to provide scientific basis for selecting suitable vascular access in HD.Methods The clinical data,selected vascular access types during first time HD in patients with ESRD in Qujing Second People＇s Hospital of Qujing City of Yunnan Province from October 2011 to December 2013 were retrospectively analyzed,with follow-up for 6 months to analyze the outcome of vascular access and the changes of therapeutic schedule. Results A total of 365 patients were enrolled in the study,in whom 225 cases were males and 140 cases were females,with average age being 51. 65 ± 18. 45 years. The main pathological causes were primary glomerulopathy（ 71. 23%）,next,diabetic nephropathy（ 10. 96%）. In first time HD most patients（ 84. 93%） selected central venous catheter（ CVC）,only a few patients（ 15. 07%） selected arteriovenous fistula（ AVF） as hemodialysis blood vessel. However after 6-month follow-up,among 340 patients,245 patients（ 72. 06%） selected AVF as permanent vascular access,21 patients（ 6. 17%） received renal transplant and the other 28 patients（ 8. 24%） received peritoneal dialysis. The Logistic regression analysis showed that males,the patients coming from the other region instead of Qujing and the patients whose glomerular filtration rate（ GFR） was lower than 5 ml · min^（-1）·（ 1. 73 m^2）^（-1） were the risk factors of selecting central venous catheters in first time HD.Conclusion Only a minority of patients select AVF in first time HD,through the cooperation of hospital aspect and patients with their families,majority of patients select finally AVF as HD access to ensure continuing performance of HD.
出处
《河北医药》
CAS
2016年第17期2579-2582,共4页
Hebei Medical Journal
基金
云南省科技计划项目(编号:2012FB162)
关键词
终末期肾病
血液透析
中心静脉导管
动静脉内瘘
end stage renal disease
hemodialysis
central venous catheter
arteriovenous fistula
