双静脉穿刺:一种血液透析血管通路替代选择的新方法

发布时间：2018-02-12 03:05

本文关键词： 双静脉穿刺血液透析血管通路透析充分性通路再循环通路相关并发症　出处：《第二军医大学学报》2016年07期 　论文类型：期刊论文

【摘要】：目的探讨双静脉穿刺作为血液透析血管通路替代选择的可行性。方法选取2014年6月至2015年6月南京军区福州总医院收治的血液透析患者84例。血管通路建立的优先级依次为自体动静脉内瘘(AVF)、带隧道带涤纶套导管(TCC)、双静脉穿刺(VVP),根据通路建立情况将患者分为VVP组、TCC组及AVF组,每组均28例。对3组患者的透析充分性、通路再循环阳性率及通路相关并发症发生率进行6个月的随访比较。结果通过6个月的随访比较,发现透析0、3、6个月时3组患者单室尿素清除指数(spKt/V)、平衡后尿素清除指数(eKt/V)、尿素下降率(URR)差异均无统计学意义(P0.05)。随访6个月后,VVP组患者通路再循环阳性率低于TCC组和AVF组(0vs 14.28%、21.43%,P0.05),通路通畅性不良发生率低于TCC组(0vs 21.43%,P0.05);3组患者通路相关感染发生率差异无统计学意义。结论 VVP操作简单,并发症及通路再循环阳性率低,透析充分性与常规通路无明显差异;在条件许可的情况下,可考虑作为AVF无法建立且无法或不愿置入TCC患者的血管通路替代选择之一。
[Abstract]:Objective to explore the feasibility of double venipuncture as an alternative to hemodialysis vascular access. Methods 84 hemodialysis patients treated in Fuzhou General Hospital of Nanjing military region from June 2014 to June 2015 were selected. The first stage was AVF with autologous arteriovenous fistula (AVF), TCC with a tunnel and a double venipuncture. The patients were divided into two groups: VVP group and AVF group. There were 28 cases in each group. The dialysis adequacy, the positive rate of pathway recirculation and the incidence of pathway-related complications were compared for 6 months. It was found that there were no significant differences in single chamber urea clearance index (SPKT / V), urea clearance index (TCC) and urea decline rate (Urea) between the three groups at 0 and 6 months after dialysis (P 0.05). After 6 months of follow-up, the positive rate of re-circulation in the patients with VVP was lower than that in the TCC group. The incidence of poor pathway opening in AVF group was lower than that in TCC group. There was no significant difference in the incidence of pathway-related infection among the three groups. Conclusion VVP is easy to operate, and there is no significant difference in the incidence of pathway-related infection among the patients in the AVF group (n = 0 vs 14.28 vs 21.43). The positive rate of complications and pathway recirculation is low, and dialysis adequacy is not significantly different from that of conventional pathway. If conditions permit, it can be considered as an alternative to vascular pathway in patients with AVF who can not be established and cannot or will not be inserted into TCC.
【作者单位】：南京军区福州总医院血液净化科;
【分类号】：R459.5

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