关键词: 维持性血液透析, 血管通路, 自体动静脉内瘘, 移植物动静脉内瘘, 带隧道和涤纶套导管

Abstract: Ｏｂｊｅｃｔｉｖｅ：To analyze the status and influencing factors of vascular access in maintenance hemodialysis (MHD) patients.
Ｍｅｔｈｏｄｏｌｏｇｙ：The clinical data and vascular access status of MHD patients were retrospectively analyzed from January 1, 2020 to December 31, 2020. Stratified analysis was conducted according to gender, age, dialysis age, primary disease, and mortality.
Ｒｅｓｕｌｔｓ：In 2020, there were 570 MHD patients in our center, including 343 males (602％) and 227 females (398％), with an average age of 6825±128 years. Among the 570 patients, there were 351 arteriovenous fistula (AVF) (616％), 30 arteriov enous graft (AVG) (53％), and 189 tunnelcuffed catheter (TCC) (332％). The AVF+AVG ratio of males was significantly higher than that of females (P<005). Grouped by age, the AVF ratios in patients≤44, 45~59, 60~74, and≥75 years were 81％, 796％, 653％, and 401％, respectively. And the AVG ratios were 48％, 62％, 58％, and 37％, respectively. Comparing the groups, the ratio of AVF+AVG in the 45-59 was the same as that in the≤44(P>005); the ratio of AVF+AVG in the≥60 was decreased, and the ratio of TCC was increased(P<005). Grouped by dialysis age, the AVF ratios in the <1, 1~5, 5~10, and>10 years were 326％, 603％, 631％, and 729％, respectively. And the AVG ratios were 0, 56％, 45％, and 76％, respectively. For comparison between groups, the AVF+AVG ratio in the>10 years was the highest, and the lowest in the <1 year(P<005). The AVF+AVG ratio was the same between the 1~5 year and the 5~10 year(P> 005). The top three primary diseases were diabetic nephropathy (DN) (456％), glomerulonephritis (GN) (211％) and hypertensive nephropathy (HTN) (156％). The AVF ratios were 60％, 725％, and 629％, respectively. The AVG ratios were 38％, 92％, and 22％, respectively. Among the groups, the ratio of AVF+AVG in the GN was significantly higher than that in DN and HTN (P<005), and it was the same in DN and HTN (P> 005); the patency of AVF+AVG in GN was significantly longer than that in DN and HTN (P<005), and it was the same in DN and HTN (P> 005). The mortality of TCC was significantly higher than that of AVF+AVG (P<005). The mortality of AVF was slightly higher than that of the AVG, the difference was not statistically significant (P>005).
Ｃｏｎｃｌｕｓｉｏｎ：The choice of vascular access is related to gender, age, dialysis age, and primary disease. DN and HTN patients have a shorter AVF／AVG patency. Reducing the use of TCC may help reduce the mortality of MHD patients.

Key words: maintenance hemodialysis, vascular access, arteriovenous fistula, arteriovenous graft, tunnel-cuffed catheter