对比不同血管通路运用于血液透析中的透析充分性及并发症发生率分析

doi:10.3969/j.issn.1000-8535.2022.05.016

摘要/Abstract

摘要： 目的对比不同血管通路运用于血液透析中的透析充分性及并发症发生率分析。方法选取我院2018年5月—2020年10月收治的其中60例血液透析患者作为研究对象,根据患者不同血管通路分为3组,甲组30例,采取自体动静脉内瘘为通路方式,乙组15例,采取聚四氟乙烯移植血管内瘘为通路方式;丙组15例,采取带隧道和涤纶套的透析导管为通路方式。观察并记录3组患者透析后的血红蛋白、高密度脂蛋白、总胆固醇、C反应蛋白、血浆清蛋白、低密度脂蛋白、尿素清除指数、甘油三酯、尿素降低率水平,并对患者随访10个月,观察3组患者血管通路并发症(感染及血栓栓塞)的发生情况。结果透析后3组患者血红蛋白、总胆固醇、高密度脂蛋白、甘油三酯、血浆清蛋白、C反应蛋白、低密度脂蛋白、尿素清除指数、尿素清除率比较,差异无统计学意义(P>0.05)。甲组的感染和血栓栓塞发生率低于乙组和丙组,而乙组的感染率又低于丙组,差异有统计学意义(P<0.05)。结论自体动静脉内瘘可以做为血液透析治疗中血管通路的首选方式,若患者自体血管条件有限,可考虑建立移植血管内瘘来保证透析的充分性,降低并发症发生率,提高患者透析安全性及生活质量。

关键词: 并发症, 血液透析, 血管通路, 带隧道和涤纶套透析导管, 移植血管内瘘, 自体动静脉内瘘

Abstract: Objective To compare the dialysis adequacy and complication incidence of different vascular access in hemodialysis. Methods A total of 60 hemodialysis patients treated in our hospital from May 2018 to October 2020 were selected as the research objects. They were divided into three groups according to different vascular access. Thirty patients in group A took autologous arteriovenous fistula (AVF) as the access, and 15 patients in group B took polytetrafluoroethylene graft (arteriovenous grafts,AVG) as the access, 15 cases in group C were treated with dialysis catheter with tunnel and polyester sleeve (tunnel-cuffed catheter,TCC). The levels of hemoglobin, high density lipoprotein, total cholesterol, C-reactive protein, plasma albumin, low density lipoprotein, urea clearance index, triglyceride and urea reduction ratio (URR) were observed and recorded. The patients were followed up for 10 months to observe the incidence of vascular access complications (infection and thromboembolism) in the three groups. Results There was no significant difference in hemoglobin, total cholesterol, high density lipoprotein, triglyceride, plasma albumin, C-reactive protein, low density lipoprotein, urea clearance index and URR among the three groups after dialysis (P>0.05). The incidence of infection and thromboembolism in group A was lower than that in group B and group C, while the infection rate in group B was lower than that in group C, the differences were statistically significant (P<0.05). Conclusions AVF can be used as the preferred way of vascular access in hemodialysis treatment. If the patient's autologous vascular conditions are limited, it can be considered to establish transplanted vascular fistula (AVG) to ensure the adequacy of dialysis, reduce the incidence of complications and improve the dialysis safety and quality of life of patients.

Key words: complications, hemodialysis, vascular access, dialysis catheter with tunnel and dacron sleeve, graft vascular fistula, autogenous arteriovenous fistula

兰薇, 郭静仪, 刘健芳, 吕敏清. 对比不同血管通路运用于血液透析中的透析充分性及并发症发生率分析[J]. 广州医药, 2022, 53(5): 80-83.

LAN Wei, GUO Jingyi, LIU Jianfang, LV Minqing. To compare the dialysis adequacy and complication rate of different vascular pathways in hemodialysis[J]. Guangzhou Medical Journal, 2022, 53(5): 80-83.

参考文献

[1] 陈洁双,伍月芳,蔡世少.整体护理联合饮食干预对血液透析患者血液生化指标的影响[J].现代医院,2020,20(4):602-603,607.
[2] 刘宏宇,赵秀宝,刘伟. 血浆置换联合血液透析滤过治疗产后溶血尿毒综合征三例疗效分析[J]. 国际妇产科学杂志,2021,48(3):264-267.
[3] 史灵芝,杨平. 分阶段护理模式联合远红外线治疗仪在动静脉内瘘术血液透析患者围透析期护理中的应用[J]. 护理实践与研究,2021,18(8):1189-1191.
[4] 中国医院协会血液净化中心分会血管通路工作组. 中国血液透析用血管通路专家共识(第2版)[J]. 中国血液净化,2019,18(6):365-381.
[5] 曹津. 规律性血液透析和骨化三醇对慢性肾功能衰竭患者治疗效果分析[J]. 中国医刊,2020,55(9):981-984.
[6] 王培莉,施素华,林巧红,等. 治疗性沟通系统改善维持性血液透析病人负性情绪的研究进展[J]. 护理研究,2020,34(9):1561-1565.
[7] 顾怡钰,杨昕宇,徐明珠,等. 腹膜透析充分性对心脏结构和功能的影响[J]. 肾脏病与透析肾移植杂志,2021,30(1):25-30.
[8] 李雪,龚文姜,杨杰,等. 费曼式学习法对提高居家腹膜透析患者的自我管理依从性及透析充分性的影响[J]. 中国血液净化,2021,20(2):134-137.
[9] 李亚南,肖芝梅,骆臣,等. 药师主导的间歇性血液透析患者药物治疗管理模式的建立与实践[J]. 药学与临床研究,2021,29(2):135-139.
[10] 程力,闵永龙,何达,等. 不同血管通路维持性血液透析患者血红蛋白的差异及相关性[J]. 中国血液净化,2020,19(1):45-48.
[11] 马骏,张仲华,童辉,等. 新型冠状病毒肺炎血液透析病人CRRT治疗的护理[J]. 护理研究,2020,34(9):1677-1678.
[12] 李志玲,王新文. 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[J]. 昆明医科大学学报,2020,41(3):116-120.
[13] 屈斌,张倩,高弼虎. 维持性血液透析患者不同血管通路类型的临床特征及全因死亡差异比较[J]. 中国血液净化,2021,20(6):367-372.

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