【摘要】目的调查中南大学湘雅二医院血液净化中心维持性血液透析(maintenance hemodialysis，MHD)患者血管通路的现状及其影响因素，探讨中心静脉临时置管对动静脉内瘘(arteriovenous fistula，AVF)的影响。方法回顾性调查截止2017 年1 月1 日在透析的343 例MHD 患者的一般资料、实验室检查、血管通路，并根据颈部静脉临时置管的有无以及其与首个成熟AVF 之间的位置关系分为同侧置管组、对侧置管组、内瘘组3 组进行比较。结果首次透析时，临时导管占比73.18%，AVF14.29%，而进入MHD(≥3 个月)后，AVF 占比达89.21%～96.50%；分组统计发现：同侧置管组的AVF 手术次数高于对侧置管组和内瘘组(H 值分别为3.618，3.846；P 值分别为0.001，＜0.001)；AVF 的初级失败率高于对侧置管组及内瘘组(χ2值分别为14.126，7.242；P 值分别为＜0.001，0.011)；1 年通畅率低于对侧置管组及内瘘组(χ2值分别为8.093，9.381；P 值分别为0.004，0.003)；3 组在AVF 的动脉瘤发生率、3 年及5 年通畅率等方面无统计学差异(H 值分别为4.191，4.045，3.717；P 值分别为0.128，0.134，0.150)。结论①AVF 是本中心首选的血管通路。②AVF 的远期通畅率不受临时导管的有无及其位置的影响，而手术次数、初级失败率、近期通畅率可能与同侧颈部临时置管有关。

【Abstract】Objective To investigate the current situation and influencing factors of vascular access in patients with maintenance hemodialysis (MHD) in the Blood Purification Center of the Second Xiangya Hospital of Central South University, and to explore the effect of temporary central venous catheterization on arteriovenous fistula (AVF). Methods We retrospectively investigated the clinical data, laboratory examination and vascular access of 343 MHD patients as of January 1, 2017. Patients were divided into three groups (ipsilateral catheterization group, contralateral catheterization group and AVF group) according to the presence or

absence of the temporary catheterization through neck veins and its side relating to the first mature AVF. Results ① The vascular access modalities at the initial of dialysis were temporary venous catheter (TVC) 73.18% and AVF 14.29%. After MHD for more than 3 months, the proportion of AVF increased to 89.21-96.5%. ②Analyses of the patients in the 3 groups found that the times of AVF surgery were higher in ipsilateral catheterization group (2.05±1.41) than in contralateral catheterization group (1.37±0.73, H=3.618, P=0.001) and AVF group (1.29 ± 0.74, H=3.846, P＜0.001); the primary failure rate of AVF was higher in ipsilateral catheterization group(23.26%) than in contralateral catheterization group (3.95%, χ2＝14.126, P＜0.001) and AVF group (4.08%, χ2＝7.242, P=0.011); the one-year patency rate was lower in ipsilateral catheterization group (73.68%) than in contralateral catheterization group (92.14%, χ2＝8.093, P=0.004) and AVF group (97.56%, χ2＝9.381, P=0.003). The presence of aneurysm and the 3-year and 5 year patency rates were similar among the three groups (H=4.191, 4.045 and 3.717 respectively; P= 0.128, 0.134 and 0.150 respectively). Conclusions ①AVF is the first choice of vascular access modality in this blood purification center. ②The long-term patency of vascular access is not affected by the presence or absence of temporary venous catheterization and its side, whereas the increased times of AVF surgery, higher primary failure rate and lower shortterm patency rate are related to the ipsilateral catheterization. AVF surgery at the opposite side of venous catheterization will reduce the times of AVF surgery and primary failure rate and increase the short-term patency rate.