摘要目的 调查国内不同级别医院终末期肾脏病患者初次血液透析(血透)血管通路应用情况,并分析初次血透未使用动静脉内瘘(内瘘)的原因.方法 采用自行设计的问卷调查北京中日友好医院和煤炭总医院、青岛大学医学院附属医院、解放军北京军区北戴河疗养院、黑龙江省佳木斯市中心医院5家医院,回顾性调查近5年内进入规律血液透析的患者,包括一般资料和初次血液透析血管通路情况,分析患者初次透析未能使用内瘘的主要原因和影响因素.结果 (1)5家医院共收集有效问卷203份,初次血液透析使用临时中心静脉置管122例(60.1％),动静脉直接穿刺44例(21.7％),动静脉内瘘35例(17.2％),带Cuff中心静脉置管2例(1.0％).5家医院初次血透通路有明显差异,4家医院以临时中心静脉置管为主,分别是中日友好医院13例(50.0％),煤炭总医院37例(77.1％),青岛大学医学院附属医院35例(85.0％),解放军北京军区北戴河疗养院13例(61.9％),而黑龙江省佳木斯市中心医院与其他医院不同,初次血透采用动静脉直接穿刺42例(61.8％).(2)调查初次透析未能使用内瘘的首位原因是患者不接受75例(44.6％),其中以心理无法接受透析最多[44例(26.2％)],其他原因分别是医生未告知[45例(26.8％)]和急性透析、时间来不及[38例(22.6％)].(3)Logistic回归分析显示,女性、受教育程度高、非农业户口患者更多在初次透析时使用内瘘.结论 我国血液透析患者初次透析内瘘的使用率偏低,血管通路应用情况在不同城市和不同等级的医院存在较大差异;患者初次透析使用内瘘受到性别、受教育程度、户口性质等多方面因素的影响,同时,医生因素也不能忽视.临床医护人员应更加重视慢性肾脏病患者血管通路的教育工作,以提升终末期肾病患者的透析质量.

abstractsObjective To investigate vascular access modalities at initiation of hemodialysis for end stage renal disease (ESRD) patients in hospitals of different levels,and to analyze the reasons contributing to the absence of arteriovenous fistula (AVF) during initial hemodialysis.Methods A pre-designed questionnaire was used to collect the information of patients that entered hemodialysis within five years,including basic information and their first vascular access types,and analyze the factors that influence patients' AVF use.Results (l) According to the 203 questionnaires returned from 5 hospitals,central venous catheter (CVC) was chosen by 122 (60.1％) patients,direct arteriovenous puncture by 44 (21.7％) patients,AVF by only 35 (17.2％) patients,and long-term cuffed catheter by 2 (1.0％) patients.For patients in different hospitals,61.7％ of patients in Jiamusi Hospital used direct arteriovenous puncture,while CVC were used most in the other four hospitals.The leading reason contributing to the absence of AVF was patient's refusal [75 cases (44.6％)],among which patients regarding AVF psychologically unacceptable accounted for the most [44 cases (26.2％)].Following that were 45 cases (26.8％),in which patients were uninformed of AVF and 38 cases (22.6％) caused by time limitation.(3) Logistic regression showed well-educated,female,and urban residential patients were more likely to choose AVF at initiation of hemodialysis.Conclusion The percentage of AVF utility at the start of hemodialysis remains low,with situation varying in different hospitals and regions.Multiple factors are associated with vascular access modalities,among which the influence of doctors cannot be ignored.More efforts should be spared on patient education to improve the dialysis quality of ESRD patients in China.