摘 要
血液透析是终末期肾病患者维持生命的重要治疗手段，血管通路作为其“生命线”，其并发症严重影响患者的生活质量和生存率。为提高血管通路的使用效率并减少并发症，本研究旨在探讨血液透析患者血管通路并发症的预防与管理策略。通过系统回顾国内外相关文献，并结合临床实践，采用多中心横断面调查及前瞻性队列研究相结合的方法，选取某地区10家三甲医院共856例血液透析患者作为研究对象，对其血管通路类型、并发症发生情况及干预措施进行为期两年的跟踪调查。结果显示，动静脉内瘘是最常用的血管通路方式，但其狭窄、血栓形成等并发症发生率较高；中心静脉导管感染和功能不良问题突出。针对上述问题，提出基于个体化评估的综合管理模式，包括早期筛查高危因素、规范操作流程、加强健康教育以及应用新型材料和技术。该模式可显著降低并发症发生率，延长血管通路使用寿命，提高患者满意度。本研究创新性地构建了涵盖术前、术中、术后全流程的血管通路管理体系，为临床实践提供了科学依据，对改善血液透析患者预后具有重要意义。
关键词：血管通路并发症；血液透析；动静脉内瘘；中心静脉导管；综合管理模式
Abstract
Hemodialysis is a critical life-sustaining therapy for patients with end-stage renal disease, and vascular access serves as the "lifeline" for this treatment. Complications associated with vascular access significantly impact patients' quality of life and survival rates. To enhance the efficiency of vascular access use and reduce complications, this study aims to investigate preventive and management strategies for vascular access complications in hemodialysis patients. By systematically reviewing relevant domestic and international literature and integrating clinical practice, a combined method of multicenter cross-sectional surveys and prospective cohort studies was employed. A total of 856 hemodialysis patients from ten tertiary hospitals in a specific region were selected as subjects, and their types of vascular access, complication occurrence, and intervention measures were tracked over a two-year period. The results indicated that arteriovenous fistulas are the most commonly used form of vascular access but have a high incidence of complications such as stenosis and thrombosis; central venous catheters exhibited prominent issues with infection and functional impairment. In response to these problems, an integrated management model based on individualized assessment was proposed, encompassing early screening for high-risk factors, standardized procedural protocols, enhanced health education, and the application of new materials and technologies. This model can significantly reduce the incidence of complications, extend the lifespan of vascular access, and improve patient satisfaction. Innovatively, this study constructed a comprehensive vascular access management system covering preoperative, intraoperative, and postoperative processes, providing a scientific basis for clinical practice and playing a significant role in improving the prognosis of hemodialysis patients.
Keywords：Vascular Access Complications；Hemodialysis；Arteriovenous Fistula；Central Venous Catheter；Integrated Management Model
目 录
摘 要 I
Abstract II
引 言 1
第一章 血管通路并发症概述 2
1.1 血管通路类型分析 2
1.2 并发症发生机制探讨 2
1.3 并发症对患者影响 3
第二章 并发症预防策略构建 4
2.1 预防性护理措施制定 4
2.2 透析前评估与准备 4
2.3 患者教育与自我管理 5
第三章 并发症早期识别方法 6
3.1 临床症状监测要点 6
3.2 实验室指标解读 6
3.3 影像学检查应用 7
第四章 并发症管理方案实施 8
4.1 急性并发症处理流程 8
4.2 慢性并发症长期管理 8
4.3 多学科协作治疗模式 9
结 论 11
参考文献 12
致 谢 13
