目的 分析临时中心静脉导管(central venous catheter,CVC)对自体动静脉内瘘(arteriovenous fistula,AVF)长期生存率的影响。方法 回顾性收集南京中医药大学附属中西医结合医院血液透析患者的一般资料,实验室检查；统计AVF初级通畅、初级功能通畅时间以及从AVF创建到首次穿刺时间、临时中心静脉置管时间。使用Logistic回归分析临时CVC与AVF生存之间的关系。采用 Kaplan-Meier生存分析比较临时CVC组患者与无临时CVC组患者，以及CVC置管时长≤42天,43～89天，≥90天3组患者的AVF初级通畅率、初级功能通畅率之间的区别。 结果 共纳入174例患者，平均年龄(58.38±15.35)岁，女性57例(32.76%)，糖尿病68例(39.08%)。与使用CVC组患者相比，未使用CVC组患者AVF创建到首次穿刺时间、AVF初级通畅时间、初级功能通畅时间均增长(Z值分别为-3.523,-2.064， -1.965； P值分别为＜0.001,0.039,0.049)；单变量二元及多变量二元Logistic回归均显示临时CVC导管与AVF生存率相关(OR =1.012，1.012；95% CI：1.000～1.024，1.000～1.025；P =0.041,0.043)。临时CVC置管时长≤42天,43～89天，≥90天3组患者的AVF初级通畅率、初级功能通畅率有统计学差异(χ2=6.354，6.926；P=0.042，0.031)。3组患者比较，血红蛋白、红细胞压积、尿素、肌酐、AVF创建到首次穿刺时间、AVF初级通畅时间、AVF初级功能通畅时间具有差异性(F /H=3.222，5.672，6.830，9.366，49.628，10.543，11.762；P =0.043，0.004，0.001，0.009，＜0.001，0.005，0.003)。 结论 临时CVC置管时间与AVF长期生存率有关，临时导管置管时间≤42天的患者AVF长期生存率更高，初级通畅时间、初级功能通畅时间更长。因此在条件允许情况下，应尽量早期移除临时CVC。
Objective The purpose of this study was to analyze the effect of temporary central venous catheterization (CVC) on long-term survival of the arteriovenous fistula (AVF). Methods We retrospectively collected the general information and laboratory examinations of hemodialysis patients treated in The Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Traditional Chinese Medicine. AVF primary patency time, AVF primary functional patency time, the time from AVF creation to first puncture, and the duration of temporary CVC were recorded. Logistic regression was used to analyze the association between temporary CVC and survival of AVF. Kaplan-Meier survival analysis was used to compare AVF primary patency rate and AVF primary functional patency rate between the CVC group and the non-CVC group, as well as among the three groups of patients with the CVC duration of ≤42 days, 43～89 days, and≥90 days. Results A total of 174 patients met the criteria for inclusion in this study. The average age was 58.38±15.35 years old, 57 cases (32.76%) were females, and 68 cases (39.08%) were complicated with diabetes. The time from AVF creation to first puncture, AVF primary patency time and AVF primary functional patency time increased significantly in the non-CVC group, as compared with those in CVC group (Z= -3.523, -2.064 and -1.965 respectively; P＜0.001, =0.039 and 0.049 respectively). Both univariate binary and multivariate binary logistic regression showed that temporary CVC was associated with AVF survival rate (OR=1.012 and 1.012; 95% CI: 1.000～1.024 and 1.000～1.025; P=0.041 and 0.043). Among the three groups of patients with temporary CVC duration of ≤42 days, 43～89 days, and ≥90 days, AVF primary patency rate and AVF primary functional patency rate were statistically different (χ2=6.354 and 6.926; P=0.042 and 0.031); hemoglobin, hematocrit, urea nitrogen, serum creatinine, the time from AVF creation to first puncture, AVF primary patency time, and AVF primary functional patency time were also statistically different (F/H=3.222, 5.672, 6.830, 9.366, 49.628, 10.543 and 11.762 respectively; P=0.043, 0.004, 0.001, 0.009, ＜0.001, 0.005 and 0.003 respectively). Conclusion This study shows that the time of temporary CVC is correlated to the long-term survival rate of AVF. The long-term survival rate of AVF, AVF primary patency time, and AVF primary functional patency were higher and longer in the group with temporary CVC time ≤42 days. Therefore, temporary CVC should be removed as early as possible when conditions permit.
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