中国血液净化

中国血液净化 ›› 2021, Vol. 20 ›› Issue (06): 415-419.doi: 10.3969/j.issn.1671-4091.2021.06.014

• 血管通路 • 上一篇    下一篇

蚌埠市维持性血液透析患者血管通路使用情况及影响因素分析

黄玉萍1,王道洋1,周玉叶1,吴雪平2,纵晓英1,李莹1,王德光3   

  1. 1蚌埠医学院第二附属医院肾脏内科
    2蚌埠医学院第一附属医院肾脏内科
    3安徽医科大学第二附属医院肾脏内科
  • 收稿日期:2020-12-30 修回日期:2021-03-30 出版日期:2021-06-12 发布日期:2021-06-17
  • 通讯作者: 王德光 wangdeguang@ahmu.edu.cn E-mail:wangdeguang@vip.163.com
  • 基金资助:
    蚌埠医学院自然科学类项目(BYKF18119)

The type of vascular access used and its influencing factors in maintenance hemodialysis patients in Bengbu city 

  1. 1Department of Nephrology, the Second Affiliated Hospital of Bengfu Medical College, Bengfu 233040, China;  2Department of Nephrology, the First Affiliated Hospital of Bengfu Medical College, Bengfu 233000, China;  3Department of Nephrology, the Second Affiliated Hospital of Anhui Medical University, Hefei 230601, China
  • Received:2020-12-30 Revised:2021-03-30 Online:2021-06-12 Published:2021-06-17

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摘要： 【摘要】目的了解蚌埠市维持性血液透析(maintenance hemodialysis，MHD)患者首次及目前血管通路使用情况及影响因素。方法对蚌埠医学院第一、第二附属医院血液透析治疗大于3 个月的患者进行问卷调查。记录患者临床资料、血管通路使用情况、血流量、并发症；分析MHD 患者不同类型血管通路的分布情况；对首次透析使用自体动静脉内瘘(arteriovenous fistula，AVF)组与中心静脉导管(central venous catheter，CVC)组患者的一般情况进行分析，并分析首次透析使用AVF 的影响因素；对MHD 患者AVF 有无并发症进行比较并分析其影响因素。结果本研究纳入198 例MHD 患者，当前患者使用血管通路的比例分别为:AVF88.38%，带隧道带涤纶套导管9.09%，移植物内瘘2.53%；首次透析使用各种血管通路的比例为：AVF29.29%，带隧道带涤纶套导管12.12%，无隧道和涤纶套的透析导管58.59%。首次透析使用AVF 组患者的受教育程度(高中及以上)及职工医保占比高于CVC 组患者(51.7%比39.3%，P= 0.010；82.8%比66.4%，P=0.038)，差异有统计学意义；多因素Logistic 回归分析显示，受教育程度高(OR=3.046, P=0.007)及职工医保(OR=5.128,P=0.005) 的患者首次透析时使用AVF 的比例较高。MHD 患者AVF 有并发症组患者的血钙、血磷、血白蛋白、三酰甘油均高于无并发症组(F=0.180,P＜0.001；F=21.637，P＜0.001；F=0.028,P=0.021；F=0.665,P=0.024)，差异有统计学意义。结论本患者队列中首次血液透析时血管通路以CVC 为主，MHD 阶段血管通路以AVF 为主。文化程度越高，医保条件越好者首次透析使用AVF比例越高。血钙、血磷、白蛋白及三酰甘油水平可能是影响AVF 并发症的危险因素。

关键词: 血液透析, 血管通路, 动静脉内瘘, 并发症

Abstract: 【Abstract】Objective To study the first and the present type of vascular access and its influencing factors in maintenance hemodialysis (MHD) patients in Bengbu city. Methods A questionnaire survey was conducted among the patients treated with hemodialysis for more than 3 months in the First and Second Affiliated Hospitals of Bengbu Medical College. Clinical data, the type of vascular access, blood flow and complications were then recorded. The distribution of different vascular access types in MHD patients was analyzed. The general conditions were compared between patients using arteriovenous fistula (AVF) and those using central venous catheter (CVC) at the first hemodialysis to obtain the influencing factors for the application of AVF at the first hemodialysis. The complications associated with AVF and their influencing factors in the MHD patients were also analyzed. Results In the 198 MHD patients enrolled in this study, the present use of AVF, tunnel-cuffed catheter (TCC) and arteriovenous graft for vascular access were 88.38%, 9.09% and 2.53% respectively, and the use of AVF, TCC and non-cuffed catheter for vascular access at the first hemodialysis were 29.29%, 12.21% and 58.59% respectively. Patients using AVF at the first hemodialysis had higher education level (high school or above high school level; 51.7% vs. 39.3%, P=0.010) and higher proportion with“medical insurance for employees”(82.8% vs. 66.4%, P=0.038), as compared with those using CVC at the first hemodialysis. Multivariate logistic regression showed that the proportion of using AVF at the first hemodialysis was higher in patients with higher education level (OR=3.046, P=0.007) and“medical insurance for employees”( OR=5.128,P=0.007). Serum calcium (F=0.180, P=0.000), phosphorus (F=21.637, P=0.000), albumin (F=0.028, P=0.021) and triglyceride (F=0.665, P=0.024) were higher in MHD patients using AVF for vascular access with complications than those without complications. Conclusion In this cohort of patients, CVC for
vascular access was frequently used at the first hemodialysis, and AVF for vascular access was commonly used at the maintenance hemodialysis period. The better the education level and medical insurance the patients had, the more likely AVF for vascular access at the first hemodialysis they accepted. Higher levels of serum calcium, phosphorus, albumin and triglyceride may be the risk factors for complications in patients using AVF for vascular access.

Key words: Hemodialysis, Vascular access, Arteriovenous fistula, Influencing factor

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