中国血液净化

中国血液净化 ›› 2020, Vol. 19 ›› Issue (07): 471-475.doi: 10.3969/j.issn.1671-4091.2020.07.010

• 血管通路 • 上一篇    下一篇

Gracz 动静脉内瘘与深静脉导管留置对血液透析患者的影响及预后因素分析

安惠旒1,祁兴敏1,王瑞1,焦霞1,王世杰2   

  1.  1Hemodialysis Center, Xingtai Third Hospital, Xingtai 054000, China;  2Department of Vasculocardiology,Xingtai People’s Hospital, Xingtai 540001, China
  • 出版日期:2020-07-12 发布日期:2020-07-15
  • 通讯作者: 王世杰 wangshijie333@126.com
  • 基金资助:
    河北省医学科学研究课题项目(项目编号：20191704)；河北省邢台市科学技术研究与发展计划项目(项目编号：2012ZC065)

Effects of Gracz arteriovenous fistula and indwelling catheter in deep vein on maintenance hemodialysis patients and analysis of the prognostic factors

  • Online:2020-07-12 Published:2020-07-15

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摘要： 【摘要】目的研究Gracz 动静脉内瘘(arteriovenous fistula，AVF)与深静脉导管留置对维持性血液透析(maintenance hemodialysis, MHD)患者透析效果和心功能、肾性贫血的影响，并分析预后的影响因素。方法选取邢台市第三医院2017 年6 月～2018 年10 月期间收治的132 例行MHD 的患者，根据血管通路方式分为深静脉导管留置组以及Gracz AVF 组。比较不同血管通路透析对超声心动图心脏结构、透析相关指标的影响，采用多因素COX 比例风险回归模型分析预后影响因素。结果Gracz AVF 组患者的尿素清除率(Kt/V)、尿素下降率(urea reduction rate,URR)以及血管通路血流量均高于深静脉导管组(t 值分别为5.478,3.588,3.350；P 值均＜0.001)。血管通路建立1 年后Gracz AVF 组的左心室舒张末期内径(left ventricular end- diastolic internal diamete,LVDd)、室间隔舒张末期厚度(intelventricular scptum end- diastolic thickness,IVSTd)明显高于深静脉导管组(t 值分别为2.357, 2.997,4.477；P 值分别为0.020, 0.003,＜0.001)。血管通路建立1 年后深静脉导管组红细胞生成素使用量明显增加(t=5.080；P＜0.001)，而Gracz AVF 组血红蛋白、血浆前白蛋白、血浆白蛋白水平明显增加(t 值分别为2.643,7.177,4.838；P 值分别为0.009，＜0.001，＜0.001)。多因素COX比例风险回归模型分析表明射血分数、舒张早期和舒张晚期左心房室瓣口最大血流速度比、甲状旁腺激素是MHD患者预后的影响因素(OR 值分别为1.980，1.914，2.065；95%CI 分别为1.119～3.502，1.046～3.500，1.275～3.344；P值分别为0.019，0.035，0.003)。结论Gracz AVF 可影响患者心脏结构和心功能，而深静脉导管留置改善肾性贫血效果较差。控制患者甲状旁腺激素水平以及超声评价心脏结构对预后有良好的指导价值。

关键词: 动静脉内瘘, 深静脉导管留置, 维持性血液透析, 心功能, 肾性贫血

Abstract: 【Abstract】Objective To study the effects of Gracz arteriovenous fistula (AVF) and indwelling catheter in deep vein on dialysis efficiency, cardiac function and renal anemia in maintenance hemodialysis (MHD) patients and analyze the prognostic factors. Methods A total of 132 MHD patients treated in Xingtai Third Hospital from June 2017 to October 2018 were divided into two groups according to the vascular access method: deep vein indwelling catheter group and Gracz AVF group. Cardiac structure by echocardiography and dialysis related indexes were compared between the two groups. The prognostic factors were analyzed by multivariate Cox proportional risk regression model. Results Kt/V, urea reduction rate (URR) and blood flow in vascular access were higher in Gracz AVF group than in deep vein indwelling catheter group (t=5.478, 3.588 and 3.350 respectively; P＜0.001). After establishment of the vascular access for one year, left ventricular enddiastolic internal diameter (LVDd) and inter-ventricular septum end-diastolic thickness (IVSTd) were significantly higher in Gracz AVF group than in deep vein indwelling catheter group (t=2.997 and 4.477; P=0.003 and ＜0.001); the use of EPO increased significantly in deep vein indwelling catheter group (t= 5.080; P＜0.001), while the concentrations of hemoglobin, prealbumin and albumin increased significantly in Gracz AVF group (t=2.643, 7.177 and 4.838 respectively; P=0.009, <0.001, and <0.001 respectively). Multivariate COX proportional risk regression model showed that ejection fraction (EF) (OR=1.980, 95% CI=1.119～3.502, P=0.019), E/A ratio (OR=1.914, 95%CI=1.046～3.500, P=0.035) and parathyroid hormone (OR=2.065, 95% CI=1.275～3.344, P=0.003) were the prognostic factors for MHD patients. Conclusion Gracz AVF for blood access can affect cardiac structure and cardiac function in MHD patients. Indwelling catheter in deep vein for blood access was less effective in improving renal anemia. Serum parathyroid hormone level and evaluation of cardiac structure by echocardiography are valuable for the estimation of prognosis in MHD patients.

Key words: Arteriovenous fistula, Indwelling catheter in deep vein, Maintenance hemodialysis, Cardiac function, Renal anemia

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