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Том 9 №4 2007 год - Нефрология и диализ

Современные тенденции в создании сосудистого доступа для гемодиализа (Обзор литературы)


Беляев А.Ю.

Аннотация: Остижения в технологии гемодиализа в конце прошлого и начале нынешнего века еще раз подтвердили мнение о приоритетном значении качества сосудистого доступа для обеспечения адекватного и безопасного программного гемодиализа (ПГД). В России дополнительный вклад в повышение актуальности вопроса вносит и значимый прогресс в диагностике заболеваний, ведущих к развитию терминальной хронической почечной недостаточности (ТХПН). Следствием этого является значительное ежегодное увеличение числа пациентов, нуждающихся в заместительной почечной терапии, эти показатели в России превышают среднемировые темпы [1]. Улучшение качества гемодиализа и, соответственно, выживаемости пациентов наряду с дефицитом почечных трансплантатов ведет к увеличению сроков нахождения больных на ПГД. Вследствие этого возрастают требования к более продолжительному функционированию сосудистых доступов для гемодиализа. Идеальным сосудистым доступом признается такой, который обеспечивает адекватный кровоток для проведения гемодиализа, функционирует длительно (многие годы) и не имеет осложнений. На сегодняшний день существует несколько основных видов сосудистых доступов, каждый из которых обладает рядом преимуществ и недостатков. В наибольшей степени требованиям, предъявляемым к оптимальному сосудистому доступу, удовлетворяет нативная артериовенозная фистула (АВФ), безоговорочно признающаяся методом выбора при формировании ПСД, что обусловлено низким уровнем осложнений и стабильной функцией в течение многих лет эксплуатации [3, 40, 49, 52, 56]. Поэтому стратегическим направлением развития области является максимально возможное увеличение доли АВФ в качестве сосудистого доступа у больных на гемодиализе [76, 85].

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Ключевые слова: программный гемодиализ, сосудистый доступ, артериовенозная фистула, синтетический сосудистый протез, центральный внутривенный катетер

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