【摘要】目的分析蚌埠地区老年维持性血液透析(maintenance hemodialysis，MHD)患者的血管通路的情况。方法纳入130 例年龄≥60 岁的MHD 患者作为老年组，162 例年龄＜60 岁的MHD 患者作为非老年组。对老年组和非老年组患者首次透析及维持透析血管通路的分布情况进行比较；并对老年MHD 患者动静脉内瘘组及导管组临床资料进行分析。结果蚌埠地区老年MHD 患者血管通路分布中，自体动静脉内瘘(arteriovenous fistula,AVF)占比62.3%，移植物内瘘(arteriovenous graft，AVG)占比0.8%，带隧道带涤纶套导管(tunneled cuffed catheter,TCC)占比36.9%。老年组和非老年组患者首次透析使用临时导管的比例较高；老年组首次透析使用临时导管的比例明显高于非老年组(χ2=18.945，P＜0.001)，非老年组首次透析使用AVF 比例高于老年组(χ2=17.505，P＜0.001)。MHD 血管通路方面老年组TCC 使用率高于非老年组(χ2=27.930，P＜0.001)。老年MHD 患者AVF 组血红蛋白(t=-7.712，P＜0.001)及白蛋白(t=- 6.323, P＜0.001) 明显高于TCC 组；AVF 组糖尿病比例(t=14.857,P＜0.001)、hsCRP(t=- 3.172, P=0.002)及血肌酐(t=4.626, P=0.033)明显低TCC 组。结论蚌埠地区老年MHD 患者血管通路构成不太理想，距我国血管通路专家共识推荐的目标还有一定的差距。患者初次血液透析及MHD 的动静脉内瘘使用率较低。MHD 患者采用AVF 通路透析对体内微炎症状态、营养状况及贫血影响较小。临床应将AVF 作为透析患者血管通路的“首要选择”，在此基础之上兼顾“个体化”选择。
【Abstract】Objective To investigate the vascular access situation in elderly maintenance hemodialysis(MHD) patients in Bengbu area. Methods A total of 130 MHD patients over 60 years old were enrolled as the elderly group, and a total of 162 MHD patients less than 60 years old were recruited as the non-elderly group. The distribution of vascular access methods at the beginning of hemodialysis and during MHD period were compared between the two groups. Clinical data in elderly group were compared between the patients using internal fistulas and those using venous catheters. Results Of the vascular access methods in elderly
group, arteriovenous fistula (AVF) accounted for 62.3%, arteriovenous graft (AVG) for 0.8%, and tunneled cuffed catheter (TCC) for 36.9%. The proportion of using provisional venous catheter as vascular access at first was relatively high in both elderly group and non-elderly group, and was higher in elderly group than in non-elderly group (χ2=18.945, P＜0.001). The proportion of using AVF as vascular access at first was higher in non-elderly group than in elderly group (χ2=17.505, P＜0.001). The proportion of using TCC as vascular access was higher in elderly group than in non-elderly (χ2=27.930, P＜0.001). In elderly group, the concentrations of hemoglobin and albumin were higher in the patients with AVF than those with TCC (t=-7.712 and -6.323 respectively; P＜0.001); the ratio of diabetes and the concentrations of serum hsCRP and creatinine were lower in the patients with AVF than those with TCC (t=14.857, -3.172 and 4.626 respectively, P＜0.001, P=0.002 and P=0.033 respectively). Conclusion The constituents of vascular access methods for elderly MHD patients in Bengbu area were unsatisfactory to the targets recommended by the Expert Consensus on Vascular Access in China. The proportion of using AVF at the beginning of hemodialysis and during MHD was lower, while this vascular access method has less effects on microinflammatory state, nutritional status
and anemia of the patients. Therefore, AVF should be adopted as the first choice of vascular access, on which individualized management can then be taken.
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