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血液透析中的血管接入挑战儿童血液透析
Doaa M Salah1, Fatina I Fadel1, Mohamed A Abdel Mawla2
1Department of Pediatrics, Pediatric Nephrology and Transplantation Unit, Kasr Alainy Faculty of Medicine, Cairo University, Cairo, Egypt.
Italian journal of pediatrics
|January 23, 2024
概括
由于血管大小的限制,儿科血液透析中的血管接入通常依赖于非手式的中央静脉导管. 动脉静脉囊是首选的,但在患有末期脏病的儿童中创造它是具有挑战性的.
科学领域:
- 儿科脏病学 儿科脏病学
- 血管接入手术 血管接入手术
- 脏替代疗法治疗 脏替代疗法
背景情况:
- 末期脏病 (ESKD) 的儿童血液透析 (HD) 的成功严重依赖于适当的血管接入 (VA).
- 开罗大学儿童医院 (CUCH) 的儿科脏病科 (PNU) 在儿科ESKD患者的VA相关挑战方面有丰富的经验.
研究的目的:
- 报告儿科脏病科小组在为ESKD进行血液透析的儿童中遇到与血管接入有关的障碍的经验.
- 分析使用的血管接入类型及其相关并发症在儿科血液透析患者群体.
主要方法:
- 从2019年到2021年进行定期血液透析的187名ESKD儿童的血管接入数据的回顾性分析.
- 卡普兰-梅尔生存分析用于动脉静脉 (AVF) 和袖口导管结局.
主要成果:
- 无手套的中央静脉导管 (CVC) 是主要的VA (97.3%),在HD开始前,只有2.7%的患者产生了动脉静脉囊 (AVF).
- 在56名患者 (29.9%) 中插入了道化CVC,在79名患者 (42.2%) 中创建了AVF.
- 导管相关的细菌病是无袖和有袖的CVC中最常见的并发症,尽管发病率有显著差异. AVF的成功率为83%,平均持续时间超过750天.
结论:
- 原生AVF是儿科血液透析的理想血管接入,但其创建通常受到儿童小血管尺寸的限制.
- 当AVF的创建是不可行的时,非手式CVC可以作为一个可行的,相对长期的替代方案.
- 转肝 (TH) 技术用于将CVC插入下腔静脉 (IVC) 提供了一个解决方案,用于具有封闭中心静脉的挑战性病例.
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