Krzanowski Marcin, Janda Katarzyna, Chowaniec Eve, Kuśnierz-Cabala Beata, Sułowicz Władysław
Katedra i Klinika Nefrologii, UJ CM, Kraków.
Przegl Lek. 2011;68(7):343-7.
The type of vascular access is an important determinant of complications in the dialysis population. The aim of the study was to evaluate types of hemodialysis vascular access at hemodialysis start, in the course of treatment and complications during a one year observation period. The study group consisted of 213 patients [126 (59%) males; 87 (41%) females] treated for 54 months (range from 2 to 384 months) by maintenance hemodialysis at the Nephrology Department of the University Hospital. Mean age of the patients equaled 57.4 years and ranged from 21 to 91 years. The observation period began on June 1st, 2009 and finished on May 31st, 2010. At the start of the dialysis therapy - 99 (46.5%) patients had arterio-venous fistula (AVF), 81 (38.0%) temporary catheters (TC), and 33 (15.5%) permanent catheters (PC). At the beginning of the one-year observation period, 161 (75.6%) of the patients were treated using an AVF, 37 (17.4%) using a CP, 11 (5.1%) CT, and 4 (1.9%) using an artificial graft (AVG). At the end of the one year observation period - 179 (84%) patients were dialyzed using AVF, while 30 (14.1%) patients on PC, and 4 (1.9%) using a AVG. Statistically significant differences in possessing AVF were noted between start of renal replacement therapy and the start and finish of the one year observation period (p < 0.0001), as well as beginning and finish of the observation period (p < 0.002). During the observation period - 37 (20.7%) patients with an AVF required intervention due to complications associated with vascular access; where 4 from 11 (36.4%) patients in this group had AVF located on the arm and 33 from 150 (22.0%) on the forearm. The most common complications associated with AVF were thrombosis (23 = 14.3%), narrowing of the fistula (9 = 5.6%), too high output flow (HOF) 2 = 1.2% and the steal syndrome (SS) 3 (1.9%). Infectious complications were noted in 4 from 37 patients with PC (10.8%), and significantly less with AVF-4 from 161 (2.5%) (p < 0.0001). AVG infection occurred in 2 (50%) individuals of this group.
AVF created using patients' own vessels of the forearm is characterized with decreased risk of complications in comparison to fistulas made of artificial materials or permanent catheters. However, fistula thrombosis of the AVF is still the most common complication requiring surgical intervention.
血管通路类型是透析人群并发症的重要决定因素。本研究的目的是评估血液透析开始时、治疗过程中以及一年观察期内的血液透析血管通路类型及并发症。研究组由213例患者组成[126例（59%）男性；87例（41%）女性]，在大学医院肾内科接受维持性血液透析治疗54个月（范围为2至384个月）。患者的平均年龄为57.4岁，年龄范围为21至91岁。观察期从2009年6月1日开始，至2010年5月31日结束。在透析治疗开始时，99例（46.5%）患者有动静脉内瘘（AVF），81例（38.0%）有临时导管（TC），33例（15.5%）有永久导管（PC）。在一年观察期开始时，161例（75.6%）患者使用AVF进行治疗，37例（17.4%）使用中心静脉导管（CP），11例（5.1%）使用隧道式中心静脉导管（CT），4例（1.9%）使用人工血管移植物（AVG）。在一年观察期结束时，179例（84%）患者使用AVF进行透析，30例（14.1%）患者使用PC，4例（1.9%）使用AVG。在肾脏替代治疗开始时与一年观察期开始和结束时之间，以及观察期开始和结束时之间，拥有AVF的情况存在统计学显著差异（p < 0.0001）。在观察期内，37例（20.7%）有AVF的患者因血管通路相关并发症需要干预；其中该组11例患者中有4例（36.4%）的AVF位于手臂，150例中有33例（22.0%）位于前臂。与AVF相关的最常见并发症是血栓形成（23例 = 14.3%）、内瘘狭窄（9例 = 5.6%）、高输出流量（HOF）2例（1.2%）和窃血综合征（SS）3例（1.9%）。37例有PC的患者中有4例（10.8%）出现感染并发症，而161例有AVF的患者中只有4例（2.5%）出现感染并发症，差异有统计学意义（p < 0.0001）。该组中有2例（50%）AVG发生感染。
与使用人工材料制成的内瘘或永久导管相比，利用患者自身前臂血管创建的AVF并发症风险较低。然而，AVF的内瘘血栓形成仍然是需要手术干预的最常见并发症。
