目的 调查基层医院维持性血管透析患者血管通路的使用现状。 方法 采用多中心横断面研究，收集2023年3月—8月盐城市大丰人民医院、安徽省明光人民医院和常州市溧阳人民医院等15家基层医院血液透析中心维持性血液透析患者的临床资料。 结果 共筛查符合标准的维持性血液透析患者650例，其中男性342例(52.62%)，女性308例(47.38%)，中位透析龄5.48(2.00，8.00)年。首次血液透析治疗血管通路类型主要为无隧道和涤纶套的透析导管291例(48.10%)和自体动静脉内瘘271例(44.79%)，目前使用的血管通路类型主要为自体动静脉内瘘518例(85.62%)，在自体动静脉内瘘维持性血液透析患者中绳梯穿刺执行率为19.30%(100例)，区域穿刺412例(79.54%)，在移植物动静脉内瘘绳梯穿刺29例(90.63%)，血管狭窄是血管通路的主要并发症，在自体动静脉内瘘和移植物动静脉内瘘中分别为177例(34.17%)和10例(31.25%)。 结论 基层医院血液透析中心维持性血液透析患者的血管通路的临床使用现状符合临床预期，但需加强相关操作规范的落实及人员培训管理工作，以早期发现血管通路功能障碍以采取积极有效干预措施。
Objective To investigate the status of vascular access in maintenance hemodialysis (MHD) patients in primary hospitals. Methods This was a multi-center and cross-sectional study, which collected clinical data of the MHD patients in the hemodialysis centers of 15 primary hospitals located in 8 regions in Jiangsu and Anhui provinces from March 2023 to August 2023. Results A total of 650 MHD patients who met the criteria were investigated, including 342 males (52.62%) and 308 females (47.38%) with a median dialysis age of 5.48 (2.00, 8.00) years. For blood access of the first hemodialysis, non-cuffed catheter was used in 291 cases (48.10%), and autologous arteriovenous fistula (AVF) was used in 271 cases (44.79%). For current blood access of hemodialysis, autologous AVF was used in 518 cases (85.62%); rope ladder puncture technique on the AVF was used in 100 cases (19.30%), and regional puncture technique was used in 412 cases (79.54%). For blood access in patients with arteriovenous graft, rope ladder puncture technique on the graft was used in 29 cases (90.63%). Vascular stenosis, the main complication of vascular access, occurred in 177 cases (34.17%) in patients with autologous AVF and in 10 cases (31.25%) in those with arteriovenous graft. Conclusion The status of vascular access in MHD patients in the hemodialysis centers in primary hospitals meets the expectations of primary hospitals. However, performance of blood access should be further standardized, and personnel training should be reinforced to find out and manage vascular stenosis earlier.
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