中南大学湘雅医院血液透析患者血管通路现状

目的：了解血液透析患者的血管通路现状。方法：回顾性分析中南大学湘雅医院血液透析中心2015年4 月1日至2016年4月1日新导入及维持性血液透析患者的基本资料、血管通路选择和并发症。结果：维持性血液透析 患者258例，采用自体动静脉内瘘(artetiovenous fistula，AVF)的患者占87.60%、带涤纶套带隧道导管占12.40%。新导入 患者61例，首次透析采用无隧道无涤纶套导管的患者占80.33%，AVF占8.19%，带涤纶套带隧道导管占9.84%，动静脉 穿刺占1.64%。AVF选择吻合血管依次为腕桡动脉-头静脉(76.55%)、肱动脉-头静脉(11.06%)、前臂中段桡动脉-头静脉 (7.08%)、肱动脉-肘正中静脉和肱动脉-贵要静脉(5.31%)。AVF发生并发症占总AVF透析人数的 34.07%，其中动脉瘤占 24.34%。结论：维持性血液透析患者绝大多数采用 AVF，而新导入透析患者中使用无隧道无涤纶套导管者比例较大。

Investigation of status for vascular access in hemodialysis patients at Xiangya Hospital of Central South University

Objective: To investigate the status of vascular access in hemodialysis patients in our center. Methods: The general information of hemodialysis patients and types and complications of vascular access at Xiangya Hospital of Central South University from April 2015 to April 2016, were retrospectively analyzed. Results: Among 258 prevalent patients, 87.60% of them had arteriovenous fistula (AVF), while 12.40% showed tunneled cuffed catheter. Of the 61 incident patients, 80.33% of them initiated dialysis with a non-tunneled and non-cuff ed catheter, 8.19% with an AVF, 9.84% with a tunneled cuffed catheter, and 1.64% with needle puncture. The types of AVF access included 76.55% of wrist radiocephalic fistula, 7.08% of mid-forearm cephalic fistula, 11.06% of elbow brachiocephalic fistula, and 5.31% of antecubital fistula and transposed basilic fistula. Seventy-seven (34.07%) patients with AVF suffered complications and wherein aneurysms accounted for 24.34%. Conclusion: In maintenance hemodialysis patients, autologous AVF is the prevalent vascular access. In the beginners for dialysis, non-tunneled and non-cuffed catheter are their choice. Additional efforts and incentives may be necessary to improve vascular access during the initiation of hemodialysis.