宜宾市2所三级医院维持性血液透析患者的血管通路调查
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摘要
目的了解宜宾市维持性血液透析(MHD)患者的血管通路情况,分析血管通路选择中存在的问题,为合理选择血管通路提供指导依据。方法采用回顾性研究的方法于2017年1月至2018年12月对宜宾市2所三级医院578例MHD患者的血管通路进行调查,包括患者基本情况、血管通路情况和并发症等。结果 578例MHD患者中选择自体动静脉内瘘(AVF)者419例,占72.5%,其次是带涤纶套带隧道导管(99例,17.1%)和人工血管移植物(AVG)(60例,10.4%);首次透析选用AVF者占32.4%(187/578),选用无涤纶套导管占64.4%(372/578),直接穿刺占3.3%(19/578);不同年龄段和透析龄MHD患者的血管通路选择比较,差异均有统计学意义(P<0.05);AVF血管选择主要是桡动脉-头静脉,其次是桡动脉-贵要静脉吻合,再次是尺动脉-贵要静脉吻合和其他动静脉吻合;吻合方式主要是动静脉端端吻合(60.4%)、端侧吻合(30.1%)和侧侧吻合(9.5%);AVF平均使用时长为(39.6±21.9)个月,平均血流量200～260 m L/min居多;AVF并发症发生率为30.5%,主要是动脉瘤、血栓、血肿和窃血综合征。结论 AVF是MHD患者首选的血管通路,特殊情况下AVG和导管也是替代选择。临床上应充分评估患者实际情况选择合适的时机建立最佳的血管通路。
Objective To survey the vascular access of maintenance hemodialysis(MHD) patients in Yibin city, analyzing the problems in vascular access options, and to provide guidance for rational selection of vascular access.Methods A retrospective study was conducted to investigate the vascular access of 578 MHD patients from two tertiary hospitals in Yibin city from January to February 2017, including basic information, vascular access and complications.Results Of the 578 MHD patients, 419 patients were performed arteriovenous fistula(AVF), accounting for 72.5%; followed by those using tunneled catheter with polyester sleeve(99 cases, 17.1%) and those with artificial vascular graft(AVG, 60 cases, 10.4%). For the first dialysis, the selection of AVF accounted for 32.4%(187/578), the choice of non-dacron catheter accounted for 64.4%(372/578), and the choice of direct puncture accounted for 3.3%(19/578). There were significant differences in vascular access options between MHD patients of different age and dialysis age(P<0.05). For AVF program, the choice of blood vessels was mainly the radial artery-cephalic vein, followed by the radial artery-basilic vein, then the ulnar artery-basilic vein, and other arteriovenous. The method was mainly end-to-end anastomosis(60.4%), end-to-side anastomosis(30.1%), and side-to-side anastomosis(9.5%). The average duration of AVF was(39.6±21.9) months, and the average blood flow was mostly 200-260 mL/min. The incidence of complications of AVF was 30.5%, mainly aneurysm, thrombosis, hematoma, and steal syndrome. Conclusion AVF is the preferred vascular access for MHD patients, AVG and catheter are also alternatives in special cases. Clinically, the patient should be fully evaluated to choose the right time to establish the optimal vascular access.
Objective To survey the vascular access of maintenance hemodialysis(MHD) patients in Yibin city, analyzing the problems in vascular access options, and to provide guidance for rational selection of vascular access.Methods A retrospective study was conducted to investigate the vascular access of 578 MHD patients from two tertiary hospitals in Yibin city from January to February 2017, including basic information, vascular access and complications.Results Of the 578 MHD patients, 419 patients were performed arteriovenous fistula(AVF), accounting for 72.5%; followed by those using tunneled catheter with polyester sleeve(99 cases, 17.1%) and those with artificial vascular graft(AVG, 60 cases, 10.4%). For the first dialysis, the selection of AVF accounted for 32.4%(187/578), the choice of non-dacron catheter accounted for 64.4%(372/578), and the choice of direct puncture accounted for 3.3%(19/578). There were significant differences in vascular access options between MHD patients of different age and dialysis age(P<0.05). For AVF program, the choice of blood vessels was mainly the radial artery-cephalic vein, followed by the radial artery-basilic vein, then the ulnar artery-basilic vein, and other arteriovenous. The method was mainly end-to-end anastomosis(60.4%), end-to-side anastomosis(30.1%), and side-to-side anastomosis(9.5%). The average duration of AVF was(39.6±21.9) months, and the average blood flow was mostly 200-260 mL/min. The incidence of complications of AVF was 30.5%, mainly aneurysm, thrombosis, hematoma, and steal syndrome. Conclusion AVF is the preferred vascular access for MHD patients, AVG and catheter are also alternatives in special cases. Clinically, the patient should be fully evaluated to choose the right time to establish the optimal vascular access.
引文
[1] FUJISAKI K, TANAKA S, TANIGUCHI M, et al. Study on dialysis session length and mortality in maintenance hemodialysis patients:The Q-Cohort study[J]. Nephron, 2018, 139(4):305-312.
[2] PORT FK, MORGENSTERN H, BIEBER BA, et al. Understanding associations of hemodialysis practices with clinical and patientreported outcomes:examples from the DOPPS[J]. Nephrol Dial Transplant, 2017, 32(suppl 2):106-112.
[3] PARISOTTO MT, PELLICCIA F, GRASSMANN A, et al. Elements of dialysis nursing practice associated with successful cannulation:result of an international survey[J]. J Vasc Access, 2017, 18(2):114-119.
[4] ENE-IORDACHE B, REMUZZI A. Blood flow in idealized vascular access for hemodialysis:a review of computational studies[J]. Cardiovasc Eng Techn, 2017, 8(3):295-312.
[5] AL-BALAS A, LEE T, YOUNG CJ, et al. The clinical and economic effect of vascular access selection in patients initiating hemodialysis with a catheter[J]. J Am Soc Nephrol, 2017, 28(12):3679-3687.
[6] ZHANG L, WANG F, WANG L, et al. Prevalence of chronic kidney disease in China:a cross-sectional survey[J]. Lancet, 2012, 379(9818):815-822.
[7]中国医院协会血液净化中心管理分会血液净化通路学组.中国血液透析用血管通路专家共识[J].中国血液净化, 2014, 13(8):549-558.
[8] RADOSA CG, RADOSA JC, WEISS N, et al. Endovascular creation of an arteriovenous fistula(endoAVF)for hemodialysis access:first results[J]. Cardiovasc Inter Rad, 2017, 40(10):1545-1551.
[9] PARK HS, KIM WJ, KIM YK, et al. Comparison of outcomes with arteriovenous fistula and arteriovenous graft for vascular access in hemodialysis:a prospective cohort study[J]. Am J Nephrol, 2016, 43(2):120-128.
[10] MASUD A, COSTANZO EJ, ZUCKERMAN R, et al. The complications of vascular access in hemodialysis[J]. Semin Thromb Hemost,2018, 44(1):57-59.
[11]任红旗,何群鹏,贾凤玉,等.维持性血液透析患者血管通路使用情况分析[J].肾脏病与透析肾移植杂志, 2017, 26(3):235-239.
[12] KALLOO S, BLAKE PG, WISH J. A patient-centered approach to hemodialysis vascular access in the era of fistula first[J]. Semin Dial, 2016, 29(2):148-157.
[13]马晓波,陈晓农.血液透析血管通路现状[J].临床肾脏病杂志,2017, 17(8):452-455.
[14] HARMS JC, RANGARAJAN S, YOUNG CJ, et al. Outcomes of arteriovenous fistulas and grafts with or without intervention before successful use[J]. J Vasc Surg, 2016, 64(1):155-162.
[15] WOO K, LOK CE. New insights into dialysis vascular access:What is the optimal vascular access type and timing of access creation in CKD and dialysis patients?[J]. Clin J Am Soc Nephrol, 2016, 11(8):1487-1494.
[16]伍刚,王荣,刘佳玮,等.日本最新(2015)血液透析血管通路指南解读[J].中国血液净化, 2017, 16(8):551-554.
[17] AL-JAISHI AA, LIU AR, LOK CE, et al. Complications of the arteriovenous fistula:a systematic review[J].J Am Soc Nephrol, 2017, 28(6):1839-1850.
[18] REDDY YNV, OBOKATA M, DEAN PG, et al. Long-term cardiovascular changes following creation of arteriovenous fistula in patients with end stage renal disease[J]. Eur Heart J, 2017, 38(24):1913-1923.
[19]焦荣红,于明月,牛慧敏,等.不同血管通路对老年维持性血液透析患者心功能、透析相关指标和实验室指标的影响[J].河北医学,2017, 39(23):3565-3568, 3571.
[20] KOSA SD, AL-JAISHI AA, MOIST L, et al. Preoperative vascular access evaluation for haemodialysis patients[J]. Cochrane Database Syst Rev, 2015, 9(9):CD007013.
[2] PORT FK, MORGENSTERN H, BIEBER BA, et al. Understanding associations of hemodialysis practices with clinical and patientreported outcomes:examples from the DOPPS[J]. Nephrol Dial Transplant, 2017, 32(suppl 2):106-112.
[3] PARISOTTO MT, PELLICCIA F, GRASSMANN A, et al. Elements of dialysis nursing practice associated with successful cannulation:result of an international survey[J]. J Vasc Access, 2017, 18(2):114-119.
[4] ENE-IORDACHE B, REMUZZI A. Blood flow in idealized vascular access for hemodialysis:a review of computational studies[J]. Cardiovasc Eng Techn, 2017, 8(3):295-312.
[5] AL-BALAS A, LEE T, YOUNG CJ, et al. The clinical and economic effect of vascular access selection in patients initiating hemodialysis with a catheter[J]. J Am Soc Nephrol, 2017, 28(12):3679-3687.
[6] ZHANG L, WANG F, WANG L, et al. Prevalence of chronic kidney disease in China:a cross-sectional survey[J]. Lancet, 2012, 379(9818):815-822.
[7]中国医院协会血液净化中心管理分会血液净化通路学组.中国血液透析用血管通路专家共识[J].中国血液净化, 2014, 13(8):549-558.
[8] RADOSA CG, RADOSA JC, WEISS N, et al. Endovascular creation of an arteriovenous fistula(endoAVF)for hemodialysis access:first results[J]. Cardiovasc Inter Rad, 2017, 40(10):1545-1551.
[9] PARK HS, KIM WJ, KIM YK, et al. Comparison of outcomes with arteriovenous fistula and arteriovenous graft for vascular access in hemodialysis:a prospective cohort study[J]. Am J Nephrol, 2016, 43(2):120-128.
[10] MASUD A, COSTANZO EJ, ZUCKERMAN R, et al. The complications of vascular access in hemodialysis[J]. Semin Thromb Hemost,2018, 44(1):57-59.
[11]任红旗,何群鹏,贾凤玉,等.维持性血液透析患者血管通路使用情况分析[J].肾脏病与透析肾移植杂志, 2017, 26(3):235-239.
[12] KALLOO S, BLAKE PG, WISH J. A patient-centered approach to hemodialysis vascular access in the era of fistula first[J]. Semin Dial, 2016, 29(2):148-157.
[13]马晓波,陈晓农.血液透析血管通路现状[J].临床肾脏病杂志,2017, 17(8):452-455.
[14] HARMS JC, RANGARAJAN S, YOUNG CJ, et al. Outcomes of arteriovenous fistulas and grafts with or without intervention before successful use[J]. J Vasc Surg, 2016, 64(1):155-162.
[15] WOO K, LOK CE. New insights into dialysis vascular access:What is the optimal vascular access type and timing of access creation in CKD and dialysis patients?[J]. Clin J Am Soc Nephrol, 2016, 11(8):1487-1494.
[16]伍刚,王荣,刘佳玮,等.日本最新(2015)血液透析血管通路指南解读[J].中国血液净化, 2017, 16(8):551-554.
[17] AL-JAISHI AA, LIU AR, LOK CE, et al. Complications of the arteriovenous fistula:a systematic review[J].J Am Soc Nephrol, 2017, 28(6):1839-1850.
[18] REDDY YNV, OBOKATA M, DEAN PG, et al. Long-term cardiovascular changes following creation of arteriovenous fistula in patients with end stage renal disease[J]. Eur Heart J, 2017, 38(24):1913-1923.
[19]焦荣红,于明月,牛慧敏,等.不同血管通路对老年维持性血液透析患者心功能、透析相关指标和实验室指标的影响[J].河北医学,2017, 39(23):3565-3568, 3571.
[20] KOSA SD, AL-JAISHI AA, MOIST L, et al. Preoperative vascular access evaluation for haemodialysis patients[J]. Cochrane Database Syst Rev, 2015, 9(9):CD007013.