| 摘要: |
| 目的 探讨双静脉穿刺作为血液透析血管通路替代选择的可行性。方法 选取2014年6月至2015年6月南京军区福州总医院收治的血液透析患者84例。血管通路建立的优先级依次为自体动静脉内瘘（AVF）、带隧道带涤纶套导管（TCC）、双静脉穿刺（VVP），根据通路建立情况将患者分为VVP组、TCC组及AVF组，每组均28例。对3组患者的透析充分性、通路再循环阳性率及通路相关并发症发生率进行6个月的随访比较。结果 通过6个月的随访比较，发现透析0、3、6个月时3组患者单室尿素清除指数（spKt/V）、平衡后尿素清除指数（eKt/V）、尿素下降率（URR）差异均无统计学意义（P>0.05）。随访6个月后，VVP组患者通路再循环阳性率低于TCC组和AVF组（0 vs 14.28%、21.43%，P<0.05），通路通畅性不良发生率低于TCC组（0 vs 21.43%，P<0.05）；3组患者通路相关感染发生率差异无统计学意义。结论 VVP操作简单，并发症及通路再循环阳性率低，透析充分性与常规通路无明显差异；在条件许可的情况下，可考虑作为AVF无法建立且无法或不愿置入TCC患者的血管通路替代选择之一。 |
| 关键词: 双静脉穿刺 血液透析 血管通路 透析充分性 通路再循环 通路相关并发症 |
| DOI：10.16781/j.0258-879x.2016.07.0884 |
| 投稿时间：2015-03-06修订日期：2015-04-28 |
| 基金项目: |
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| Veno-venous puncture: a new alternative method of vascular access on hemodialysis |
| WANG Jia,YU Yi*,SUN Shu-qing,WANG Yan,LIN Yue-yong,CHEN Jin,HE Ming-en,XUE Yan |
(Department of Blood Purification, Fuzhou General Hospital, PLA Nanjing Military Area Command, Fuzhou 350025, Fujian, China
* Corresponding author) |
| Abstract: |
| Objective To investigate the feasibility of veno-venous puncture (VVP) as an alternative for temporary and long-term vascular access in hemodialysis patients. Methods A total of 84 hemodialysis patients were enrolled in this study in Fuzhou General Hospital, PLA Nanjing Military Area Command between June 2014 and June 2015.The priority order of vascular access is as follow:arteriovenous fistula (AVF), tunneled cuffed catheter (TCC), and VVP. Patients were divided into VVP group (n=28), TCC group (n=28) and AVF group (n=28). Dialysis adequacy, access recirculation rate and access complications were observed and compared among each group for a follow-up of 6 months. Results There were no significant differences in spKt/V, eKt/V or urea reduction ratio (URR) among the three groups at 0, 3 and 6 months after dialysis. After 6 months, the access recirculation rate in VVP group was significanlty lower than that in the other two groups (0 vs 14.28%, 21.43%; P<0.05), and access dysfunction rate in VVP group was also significantly lower than that in TCC group (0 vs 21.43%, P<0.05), while the access-related infection rates were not significantly different among three groups. Conclusion VVP is easy to perform, with less complications and low access recirculation rate, and it might be an alternative choice for hemodialysis when AVF cannot be created or TCC cannot be placed. |
| Key words: veno-venous puncture hemodialysis vascular access dialysis adequacy access recirculation vascular access complications |
