中国血液净化

中国血液净化 ›› 2018, Vol. 17 ›› Issue (08): 549-552.doi: 10.3969/j.issn.1671-4091.2018.08.010

• 血管通路 • 上一篇    下一篇

双静脉穿刺在血液透析临时血管通路中的应用

王佳1,2,余毅1,孙淑清1,王琰1,林曰勇1,陈今1,何明恩1,薛艳1   

  1. 1 南京军区福州总医院血液净化科,
    2 厦门市第二医院肾内科
  • 收稿日期:2017-09-28 修回日期:2018-05-27 出版日期:2018-08-12 发布日期:2018-08-12
  • 通讯作者: 余毅 yuyicn@126.com E-mail:yuyicn@126.com

Application of veno-venous puncture as the temporary vascular access in hemodialysis patients

  • Received:2017-09-28 Revised:2018-05-27 Online:2018-08-12 Published:2018-08-12

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摘要： 【摘要】目的目前，未能及时建立长期血管通路的CKD5 期患者只能依靠中心静脉置管开始透析，对患者预后存在不良影响。本研究的目的为探讨双静脉穿刺作为初始透析患者血管通路替代选择的可行性。方法选取2014 年6 月～2015 年6 月间南京军区福州总医院因各种原因未及时建立自体动静脉内瘘或移植物动静脉内瘘的初始透析患者66 例,使用随机数字表法分为双静脉穿刺组33 例及长期管组33例。入组后安排内瘘手术，由开始测试至内瘘成熟期间对2 组患者间的透析充分性、通路再循环阳性率及通路相关并发症发生率进行2 个月的随访比较。结果2 组患者入组时一般情况及各项检查指标差异均无统计学意义，具有可比性。对2 组患者进行2 个月随访比较，双静脉穿刺组与长期管组相比，单室尿素清除指数(spKt/V)、平衡后尿素清除指数(eKt/V)、尿素氮下降率(urea reduction rate，URR)差异均无统计学意义(P 值分别为0.501,0.509，0.747)，通路通畅性不良发生率低于长期管组(0%比12.12%，χ2=4.192，P=0.041)，2 组间通路再循环阳性率及通路相关感染发生率差异无统计学意义。结论双静脉穿刺操作简单，建立通路后即可开始透析，可作为初始透析或通路失功患者的临时血管通路替代选择。

关键词: 双静脉穿刺, 血液透析, 血管通路, 透析充分性, 通路再循环, 血管通路相关并发症

Abstract: 【Abstract】Background At present, patients who do not establish long-term vascular access can only rely on central venous catheter (CVC) as the temporary vascular access for dialysis. However, CVC has an adverse impact on the prognosis of patients. The purpose of this study was to investigate the feasibility of venovenous puncture (VVP) as an alternative for temporary vascular access in incident hemodialysis patients. Methods A total of 66 incident hemodialysis patients treated in Fuzhou General Hospital of Nanjing Military Command during the period from June 2014 to June 2015 were enrolled in this study. Patients were randomly divided into VVP group (n=33) and CVC group (n=33). Dialysis adequacy, access recirculation rate and access complications in a follow-up period of 2 months were observed and compared between the two groups. Results There were no significant differences in spKt/V, eKt/V and urea reduction ratio (URR) between the two groups at 0, 1 and 2 months after dialysis. After 2 months, the access dysfunction rate in VVP group was lower than that in CVC groups (0% vs. 12.12%, χ2=4.192, P=0.041). The dialysis adequacy and vascular access complications rate were similar between the two groups. Conclusion VVP is easy to perform and it can be an alternative choice for temporary vascular access in incident hemodialysis patients.

Key words: Veno-venous puncture, Hemodialysis, Vascular access, Dialysis adequacy, Access recirculation, Vascular access complications