血液透析患者不同血管通路透析充分性及炎症状态的比较

目的:通过比较不同血管通路血液透析患者透析充分性以及患者炎症状态营养不良状况,探讨血液透析患者理想的血管通路。方法:选择本院2009年1月～2010年1月采用长期血管通路进行血液透析的患者55例,随访9～12月,对比采用自体动静脉内瘘(AVF)与颈内静脉带袖套隧道导管(CTC)透析患者的Kt/V值、C反应蛋白(CRP)、白蛋白(ALB)、前白蛋白(PA)、血红蛋白(HGB)以及血管通路相关并发症的发生率。结果:55例患者中采用AVF40例,采用CTC患者15例,AVF组与CTC组患者Kt/V值均>1.2,两组相比较AVF组优于CTC组(P<0.01);AVF组患者CRP较CTC组低(P<0.01),ALB、HGB均高于CTC组(P<0.05)。结论:采用AVF与CTC两种血管通路的透析患者均能达到充分透析的效果,但AVF组患者在并发症、炎症状态方面优于CTC组,仍做为首选血管通路。

Comparison of dialysis adequacy and inflammation in hemodialysis patients with different vascular access

Objective:To find out the favorable vascular access for dialysis patients through comparing the dialysis adequacy and malnutrition-inflammation between different procedures.Methods: Fifty-five renal patients undergone long-term access for hemodialysis between Jan.2009 and Jan.2010 were enrolled in and examined in a follow-up period of 9 to 12 months for comparing the Kt/V values by using vascular access of arteriovenous fistulae(AVF) or cuffed and tunneled catheter(CTC) in an internal jugular vein,concentrations of C-reaction protein(CRP),albumin(ALB),prealbumin(PA)and hemoglobin(HGB),and complications associated with vascular access.Results: Of the 55 hemodialysis patients,40 underwent native AVF and 15,CTC as the long-term vascular access for hemodialysis.Although Kt/V values were greater than 1.2 for the two groups of patients,yet,the outcomes in AVF group were superior to that of CTC group(P<0.01).Still,the patients in AVF group had lower CRP level but higher ALB,HGB as compared with CTC group(P<0.01).Conclusion: Vascular access either with AVF or CTC will lead to the similar outcomes,nevertheless,the former has fewer complications and lower incidence of nutrition/inflammation,and is preferably for clinical recommendation.