摘要
目的比较自体动静脉内瘘(AVF)和带隧道带涤纶套的导管(TCC)2种血管通路在老年维持性血液透析(MHD)患者中的应用效果。方法选取老年MHD患者103例,按照不同血管通路分为AVF组(43例)和TCC组(60例),比较2组接受规律血液透析治疗1年后于透析当日实验室指标:血肌酐、尿酸、甲状旁腺激素、血钙、血磷、血红蛋白、甘油三酯、总胆固醇;血管通路血流量、尿素清除率;规律血液透析治疗1年后复查超声心动图,检测患者左心室舒张末期内径(LVEDd)、左心室后壁舒张末期厚度(LVPWT)、室间隔舒张末期厚度(IVSTd)、左心室射血分数(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)、肺动脉压;出现左心室收缩功能障碍和舒张功能障碍的发生率;记录患者透析期间发生透析通路相关感染、机械性损伤及心力衰竭的情况。结果2组患者实验室指标比较差异均无统计学意义(P>0.05)。AVF组患者的LVEDd、IVSTd、LVPWT、左心室收缩功能障碍、舒张功能障碍发生率、血管通路血流量、尿素清除率、机械性损伤发生率均高于TCC组,而透析通路相关感染发生率、E/A、EF值均低于TCC组(P<0.05),2组间肺动脉压及心力衰竭发生率差异无统计学意义(P>0.05)。结论对于老年MHD患者,应在评估其基础疾病及血管条件等各方面因素后再确定适宜的透析通路。
Objective To compare the effects of 2 vascular accesses via arteriovenous fistula(AVF)and tunnel-cuffed catheter(TCC)in elderly patients with maintenance hemodialysis(MHD).Methods A total of 103 elderly MHD patients were selected and divided into the AVF group(43 cases)and the TCC group(60 cases)according to different vascular pathways.Laboratory indexes of serum creatinine,uric acid,parathyroid hormone(PTH),serum calcium,blood phosphorus,hemoglobin,triglyceride and total cholesterol were compared between the two groups on dialysis day after receiving regular hemodialysis treatment for 1 year.Blood flow and urea clearance in vascular pathway were also compared between the two groups.The left ventricular end-diastolic diameter(LVEDd),the left ventricular posterior end-diastolic thickness(LVPWT),the ventricular septal end-diastolic thickness(IVSTd),ejection fraction(EF),the maximum flow velocity ratio(E/A)of the left atrial ventricle at the early and late diastolic stages and pulmonary artery pressure were examined by echocardiography after regular hemodialysis treatment for 1 year.The occurrence rates of left ventricular systolic dysfunction and diastolic dysfunction were recorded.Hemodialysis access associated infection,mechanical injury and heart failure during dialysis were also recorded.Results There were no significant differences in laboratory indexes between the two groups(P>0.05).LVEDd,IVSTd,LVPWT,incidence rates of left ventricular systolic dysfunction,diastolic dysfunction,blood flow through vascular channels,Kt/V and mechanical injury were higher in the AVF group than those in the TCC group,while the ratio of hemodialysis access associated infection,E/A and EF values were lower in the AVF group than those in the TCC group(P<0.05).There were no significant differences in incidence rates of pulmonary arterial pressure and heart failure between the two groups(P>0.05).Conclusion For elderly MHD patients,the appropriate dialysis access should be determined after evaluating underlying diseases and vascular co
作者
李朝园
赵富浩
陈莎
吕睿倩
武子霞
LI Chaoyuan;ZHAO Fuhao;CHEN Sha;LYU Ruiqian;WU Zixia(Department of Nephrology,Tianjin Hospital,Tianjin 300211,China)
出处
《天津医药》
CAS
2024年第12期1266-1269,共4页
Tianjin Medical Journal
基金
天津市科技计划项目(23JCQNJC01430)。
关键词
动静脉瘘
肾透析
导管
留置
手术后并发症
心功能
透析充分性
arteriovenous fistula
renal dialysis
catheters,indwelling
postoperative complications
cardiac function
dialysis adequacy
