中国血液净化

中国血液净化 ›› 2024, Vol. 23 ›› Issue (06): 453-456.doi: 10.3969/j.issn.1671-4091.2024.06.012

• 血管通路 • 上一篇    下一篇

西藏地区血液净化质量控制单位单中心维持性血液透析患者血管通路现况分析

索朗曲珍     阿  勇    李国梁     崔  专     唐  雯   

  1. 850000 拉萨，1西藏自治区人民医院肾内科
    100191 北京，2北京大学第三医院肾内科
  • 收稿日期:2024-01-19 修回日期:2024-03-18 出版日期:2024-06-12 发布日期:2024-06-12
  • 通讯作者: 唐雯 E-mail:tanggwen@126.com
  • 基金资助:
    西藏自治区医院院内科研课题(XZQYY2024010)；北京大学第三医院临床队列建设项目(BYSYDL2023004)

A cross-sectional analysis of vascular access in maintenance hemodialysis patients in a large single center in Tibet

SUOLANG Qu-zhen,  A Yong,  LI Guo-liang,  CUI Zhuan,  TANG Wen   

  1. Department of Nephrology, Tibet Autonomous Region People's Hospital, Lasa 850000, China; 2Department of Nephrology, Peking University Third Hospital, Beijing 100191, China
  • Received:2024-01-19 Revised:2024-03-18 Online:2024-06-12 Published:2024-06-12
  • Contact: 850000 拉萨，1西藏自治区人民医院肾内科；100191 北京，2北京大学第三医院肾内科 E-mail:tanggwen@126.com

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摘要： 的 调查西藏地区血液净化质量控制单位血管通路现况。 方法 以2021年12月─2022年12月在西藏自治区人民医院血液净化中心进行维持性血液透析(maintenance hemodialysis，MHD)的患者为研究对象。 结果 共纳入194例患者，使用临时静脉置管、带隧道和涤纶套导管(tunnel-cuffed catheter，TCC)、移植物动静脉内瘘(arteriovenous graft，AVG)和自体动静脉内瘘(arteriovenous fistula，AVF)作为首次血管通路的比例分别为34.0%、45.4%、1.0%和19.6%。24.2%患者在透析前完成造瘘。提前造瘘和未提前造瘘的患者比，男性(χ²=3.919,P=0.048)和大学及以上学历(χ²=17.875,     P＜0.001)更多；和未提前造瘘组相比，提前造瘘组患者透析后以AVF或AVG为血管通路的比例更高(χ²=4.860,P=0.029)。在MHD患者中，以AVF、AVG、TCC为血管通路的比例分别为86.6%、2.6%、10.8%。和使用AVF或AVG的患者相比，使用TCC为血管通路的患者年龄更大(t=2.039,P=0.043)，原发性肾小球肾炎更少(χ²=4.213,P=0.040)。透析开始血管通路为临时中心静脉导管的患者(n=66)和其它血管通路患者(n=128)相比，有更高的比例以TCC作为MHD血管通路(χ²=8.157，P=0.007)。 结论 AVF使用率符合指南要求，TCC使用率略高于指南要求,需要技术提高和加强教育。

关键词: 血管通路, 动静脉内瘘, 血液透析

Abstract: Objective A cross-sectional analysis of vascular access for hemodialysis in a large hemodialysis center in Tibet.  Methods Patients undergoing maintenance hemodialysis (MHD) in the Blood Purification Center, the People's Hospital of Tibet Autonomous Region from December 2021 to December 2022 were recruited for the analysis. Demographic characteristics, primary disease, dialysis vintage, the first and current vascular access modality were collected.  Results  A total of 194 MHD patients were included in the analysis. Vascular access used temporary central venous catheter, tunnel-cuffed catheter (TCC), arteriovenous graft (AVG) and arteriovenous fistula (AVF) for the first dialysis access were found in 66(34.0%), 88(45.4%), 2(1.0%), and 38(19.6%) patients, respectively. Forty-seven patients (24.2%) completed the AVF construction surgery before dialysis. In the patients with AVF surgery before dialysis, there were more male patients (83% vs. 68%, χ²=3.919, P=0.048), more patients with a college education or above (53.2% vs. 21.1%, χ²=17.875, P<0.001), and more patients using AVF or AVG as the vascular access (97.9% vs. 86.4%, χ²=4.860, P=0.029), as compared with those without AVF surgery before dialysis. AVF, AVG and TCC were used as the vascular access for MHD in 86.6%, 2.6% and 10.8%, respectively, of all MHD patients. Compared with the patients using non-TCC access, TCC as the vascular access was usually found in patients with older age (58.3±15.0 vs. 51.7±13.8, t=2.039, P=0.043) and less likely to have glomerulonephritis as the cause of renal failure (23.8% vs. 47.4%, χ²=4.213, P=0.040). Patients with temporary central venous catheter as the initial vascular access (n=66) were more likely to use TCC for MHD (19.7% vs. 6.3%, χ²=8.157, P=0.007), as compared with the patients using other vascular access (n=128).  Conclusion  AVF as the vascular access for MHD in this center was 86.6%, compliant with the requirement of the guidelines. However, the use of TCC was 10.8%, slightly higher than the requirement of the guidelines. Improvement of technology and pre-dialysis education are warranted to reduce the use of TCC for MHD.

Key words: Vascular access, Arteriovenous fistula, Hemodialysis

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