Abstract: Objective　To compare arteriovenous fistula and long-term catheter for maintained hemodialysis patients in terms of patients’cardiac function，and analyse the prognostic factors. Methods　A total of 219 patients who received maintained hemodialysis in the Second Hospital of Tianjin Medical University from 2010 to 2012 were enrolled in this study.Patients were divided into two groups according to vascular access for hemodialysis,arteriovenous fistula group（n=109） and long-term catheter group（n=110）.The general data and Kt/V were recorded,echocardiographic assessment of left ventricular function were investigated.The mortality and cause of death were documented with a 1-year follow-up．Results　There were statistically significant differences of diastolic blood pressures,hemoglobin,primary disease between the two groups （P<0.05）.There was no statistically significant difference of Kt/V between the two groups （P>0.05）.The incidences of left ventricular hypertrophy and left ventricular stystolic dysfunction in arteriovenous fistula group were higher than those in long-term catheter group （P<0.05）.There was no significant difference of cardiovascular mortality between arteriovenous fistula group（4.6%，5/109） and long-term catheter group （63.6%，7/110；χ2=0.334,P=0.564）.Systolic blood pressure〔HR=0.991，95%CI（0.981，0.999）〕,diastolic blood pressure 〔HR=0.981，95%CI（0.966，0.988）〕,serum calcium 〔HR=2.240，95%CI（1.042，6.321）〕 and PTH〔HR=1.004，95%CI（1.001，1.022）〕 were the independent influencing factors of cardiovascular mortality for patients on maintained hemodialysis by Cox proportional hazard regression model analysis.Conclusion　Maintained hemodialysis patients with arteriovenous fistula were more susceptible to left ventricular dysfunction.It was important for improving long-term outcomes of patients with maintained hemodialysis to control blood pressure,maintain normal serum calcium and reduce PTH levels.

Key words: Hemodialysis, Tunneled cuffed catheter, Arteriovenous fistula, Ventricular function,left

摘要： 目的　比较选择动静脉内瘘与长期导管对维持性血液透析患者心功能的变化，探讨预后的影响因素。方法　选取2010—2012年于天津医科大学第二医院进行维持性血液透析的患者219例为研究对象，根据维持性血液透析采用的血管通路，将患者分为动静脉内瘘组（109例）和长期导管组（110例）。收集患者一般资料，记录尿素清除率（Kt/V），采用超声心动图检查患者左心室功能，记录两组患者入组后1年内的死亡情况及死亡原因。结果　两组患者舒张压（DBP）、血红蛋白（Hb）水平、原发疾病构成比较，差异均有统计学意义（P<0.05）。两组Kt/V比较，差异无统计学意义（P>0.05）。动静脉内瘘组患者左心室肥厚、收缩功能障碍发生率高于长期导管组（P<0.05）。动静脉内瘘组心血管事件病死率（4.6%，5/109）与长期导管组（63.6%，7/110）比较，差异无统计学意义（χ2=0.334,P=0.564）。多因素Cox比例风险回归模型分析显示，收缩压〔HR=0.991，95%CI（0.981，0.999）〕、DBP〔HR=0.981，95%CI（0.966，0.988）〕、血钙〔HR=2.240，95%CI（1.042，6.321）〕、甲状旁腺激素〔HR=1.004，95%CI（1.001，1.022）〕水平是维持性血液透析患者发生心血管事件死亡的影响因素（P<0.05）。结论　通过动静脉内瘘进行维持性血液透析患者更易发生左心室功能异常，对维持性血液透析患者控制血压水平、维持正常血钙水平、降低PTH水平均可能有助于改善长期预后。

关键词: 血液透析, 长期导管, 动静脉内瘘, 心室功能, 左