中国血液净化

中国血液净化 ›› 2026, Vol. 25 ›› Issue (02): 160-164.doi: 10.3969/j.issn.1671-4091.2026.02.016

• 血管通路 • 上一篇    下一篇

不同血管通路在危重血液透析患者延长间歇肾脏替代治疗中的应用研究

曾维玲   杜丹丹   周先可   钟丽莉   袁晓玲   黄 鲜   黄金平   

  1. 611130 成都，成都市第五人民医院1肾内科 2重症监护室
  • 收稿日期:2025-06-16 修回日期:2025-08-24 出版日期:2026-02-12 发布日期:2026-02-02
  • 通讯作者: 黄金平 E-mail:611130 成都，成都市第五人民医院1 肾内科
  • 基金资助:
    四川省老年医学临床医学研究中心开放课题(成都医学院-四川三松医疗管理集团有限公司联合科研基金专项：24LNYXSSB01，24LNYXSSB02)；四川省医疗卫生与健康促进会科研项目(KY2024SJ0035)

Study on different vascular accesses in prolonged intermittent renal replacement therapy for criticallyill hemodialysis patients

ZENG Wei-ling, DU Dan-dan, ZHOU Xian-ke, ZHONG Li-li, YUAN Xiao-ling, HUANG Xian, HUANG Jin-ping   

  1. 1Department of Nephrology and 2 Intensive Care Unit, Chengdu Fifth People's Hospital, Chengdu 611130, China
  • Received:2025-06-16 Revised:2025-08-24 Online:2026-02-12 Published:2026-02-02
  • Contact: 611130 成都，成都市第五人民医院1肾内科 E-mail:611130 成都，成都市第五人民医院1 肾内科

摘要： 目的 探讨自体动静脉内瘘(autogenous arteriovenous fistula,AVF)与临时中心静脉导管(central venous catheter,CVC)在危重维持性血液透析(maintenance hemodialysis,MHD)患者延长间歇肾脏替代治疗(prolonged intermittent renal replacement therapy,PIRRT)中的临床效果、安全性及经济效益。 方法 纳入2025年1月─5月在成都市第五人民医院住院需行PIRRT的危重MHD患者(n=60)，采用随机数字表法将患者分为塑料套管针穿刺AVF组(n=30)和CVC组(n=30)，比较2组的透析充分性(Kt/V值)、通路相关并发症发生率(出血、感染、血栓)、住院时间、总治疗费用及预后的情况。 结果 AVF组平均Kt/V值高于CVC组(t=2.146，P=0.036)。AVF组血管通路相关并发症发生率、患者平均住院时间、总治疗费用均低于CVC组(χ²/t=8.444、-2.308、-2.018，P＜0.001、0.025、0.048)。CVC组导管相关 并 发 症(导 管 相 关 感 染、中 心 静 脉 血 栓 和 出 血)发 生 率 为 36.67%。2 组 28 d 生 存 率 无 显 著 差 异(χ²=0.209，P=0.648)。 结论 危重MHD患者行PIRRT时，选择动静脉内瘘作为血管通路可提升疗效、降低感染等血管通路并发症，值得临床进一步实践探索。

关键词: 维持性血液透析, 血管通路, 延长间歇肾脏替代治疗, 危重患者

Abstract: Objective To investigate the clinical efficacy, safety, and economic benefits of two vascular
accesses: autologous arteriovenous fistula (AVF) and temporary central venous catheter (CVC), in prolonged
intermittent renal replacement therapy (PIRRT) for critically ill maintenance hemodialysis (MHD) patients.
Methods Sixty critically ill MHD patients requiring PIRRT and admitted to the Fifth People's Hospital of
Chengdu between January and May 2025 were enrolled in this study. Using a random number table, they were
randomly assigned to AVF group (undergoing plastic trocar puncture, n=30) or CVC group (n=30). The two
groups were compared in terms of dialysis adequacy (Kt/V value), incidence of access- related complications
(infection, thrombosis and bleeding), length of hospital stay, total treatment expenses, and prognosis. Results
The average Kt/V value in the AVF group was higher than that in the CVC group (1.39±0.17 vs. 1.29±0.17, t=
2.146, P=0.036). The incidence of access-related complications was significantly lower in the AVF group than
in the CVC group (3.33% vs. 36.67%, χ² =8.440, P＜0.001). In particular, the incidence of catheter- related
complications (catheter-related infection, central venous thrombosis, and bleeding) was as high as 36.67% in
the CVC group. The length of hospital stay in the AVF group was shorter than that in the CVC group (10.83±
3.84 vs. 12.93±3.56 days, t=-2.308, P=0.025), and the total treatment expenses in the AVF group was lower
than that in the CVC group (24 394.48±11 953.48 yuan vs. 32 339.92±17 950.68 yuan, t=-2.018, P=0.048).
There was no significant difference in the 28-day survival rate between the two groups (93.33% vs. 90.00%,
χ²=0.209, P=0.648). Conclusion For critically ill MHD patients undergoing PIRRT, selecting AVF as the vascular access can improve treatment efficacy, reduce access- related complications (e.g., infection) and lower
medical expenses, being worthy of further clinical application and exploration.

Key words: Maintenance hemodialysis, Vascular access, Prolonged intermittent renal replacement therapy, Critically ill patient

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