Anticoagulation treatments related different types of vascular access on maintenance hemodialysis patients：a multi-center epidemiological investigation.

doi:10.7504/nk2014050303

Anticoagulation treatments related different types of vascular access on maintenance hemodialysis patients：a multi-center epidemiological investigation.

HUANG Qi*，SUN Xue-feng，LIN Hong-li，ZHANG Zhi-min，HAO Li-rong，YAO Li，LI Ji-jun，ZHAO De-long，WANG Yong，ZHU Han-yu，CHEN Xiang-mei.

*Department of Nephrology，Chinese PLA General Hospital，State Key Laboratory of Kidney Disease(2011DAV00088)，Beijing 100853，China

Online:2014-06-01 Published:2014-06-03

维持性血液透析血管通路抗凝治疗多中心流行病学研究

黄琪1，孙雪峰1，林洪丽2，张智敏3，郝丽荣4，姚丽5，李冀军6，赵德龙1，王涌1，朱晗玉1，陈香美1

作者单位：1.解放军总医院肾脏病国家重点实验室，北京 100853；2.大连医科大学附属第一医院肾内科，辽宁大连 116011；3.总参谋部总医院肾内科，北京 100094；4.哈尔滨医科大学附属第一医院肾内科，哈尔滨 150001；5.中国医科大学附属第一医院肾内科，沈阳 110001；6.解放军总医院附属第一医院肾内科，北京 100853

通讯作者: 孙雪峰
基金资助:
国家重点基础研究发展规划(2013CB530800)；国家自然科学基金(81270819)；国家科技支撑计划项目(2011BAI10B00)；卫生行业科研专项项目(201002010)

Abstract

Abstract:

Objective To increase the understanding of vascular access in hemodialysis and to evaluate hemodialysis-related anticoagulation treatments and the associated hemorrhagic or thrombotic complications.Methods In this study，an epidemiological investigation was conducted in 1175 patients who underwent hemodialysis in seven blood purification centers in northern Chinese.The patients were divided into two groups based on the vascular access they used：arteriovenous fistula (AVF) group and central venous catheter (CVC) group.Results AVF was the most frequently used vascular access，and heparin was the most commonly used anticoagulant.Patients in CVC group experienced significantly greater rates of low molecular weight heparin (LMWH) administration，and had a higher rate in achieving thrombotic complications than those in AVF group.There were no significant differences in LMWH dosages in patients with thrombotic complications，as well as the proportion of patients who received antiplatelet drugs.Heparinized catheter lock solutions were excessively high in this study，which may lead to a risk of hemorrhage.Conclusion Hemodialysis-related anticoagulation treatments in China require additional improvements，especially for the patients using CVC as vascular access.There is an urgent need to develop clinical evaluation studies of anticoagulation treatments for achieving more standardized and targeted treatments.

Key words: hemodialysis, anticoagulants, vascular access

摘要：

目的了解血液透析患者血管通路的使用和维护情况，并评估患者的抗凝治疗以及出血、血栓并发症的情况。方法对中国北方城市7个血液净化中心的1175例患者进行血液透析血管通路选择及抗凝治疗的流行病学调查。依据血管通路不同，分为自体动静脉内瘘组(AVF)及长期留置中心静脉导管组(CVC)，比较两组患者抗凝治疗及出血、血栓并发症的异同。结果中国北方城市血液透析患者最常使用的血管通路为自体动静脉内瘘，最常用的抗凝剂是普通肝素。CVC组患者更多选择低分子肝素(LMWH)做为抗凝剂，其血栓并发症的发生率高于AVF组；并发血栓的患者没有增加LMWH的使用剂量，也没有增加口服抗血小板药物的使用率；中心静脉导管的肝素封管浓度明显过高，可能给患者带来出血风险。结论中国血液透析的抗凝治疗尚需改进，尤其是对于使用CVC的患者。有必要开展临床评价研究，建立适宜的抗凝方案，推进血液透析患者抗凝治疗的规范化和标准化。

关键词: 血液透析, 抗凝药, 血管通路

CLC Number:

459.5

HUANG Qi*，SUN Xue-feng，LIN Hong-li，ZHANG Zhi-min，HAO Li-rong，YAO Li，LI Ji-jun，ZHAO De-long，WANG Yong，ZHU Han-yu，CHEN Xiang-mei.. Anticoagulation treatments related different types of vascular access on maintenance hemodialysis patients：a multi-center epidemiological investigation.[J]. Acta Metallurgica Sinica, DOI: 10.7504/nk2014050303.

黄琪1，孙雪峰1，林洪丽2，张智敏3，郝丽荣4，姚丽5，李冀军6，赵德龙1，王涌1，朱晗玉1，陈香美1. 维持性血液透析血管通路抗凝治疗多中心流行病学研究[J]. 中国实用内科杂志, DOI: 10.7504/nk2014050303.

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2014-04-02收稿本文编辑：颜廷梅

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