维持性血液透析患者动静脉内瘘血栓形成危险因素分析  

Risk factors of thrombosis in internal arteriovenous fistula in maintenance hemodialysis patients

作　　者：叶蔚蔚[1] 雷文辉[1] 毛明锋[1] 张彬娥[1] 章巧庆[1] 吴华芬[1] Ye Weiwei Lei Wenhui Mao Mingfeng Zhang Bin＇e Zhang Qiaoqing Wu Huafen(Blood Purification Center, Lishui Central Hospital, Lishui 323000, Chin)

机构地区：[1]浙江省丽水市中心医院血液净化中心,323000

出　　处：《中华现代护理杂志》2016年第21期3018-3023,共6页Chinese Journal of Modern Nursing

摘　　要：目的探讨维持性血液透析患者动静脉内瘘血栓形成的相关护理因素及改进措施。方法采用病例对照研究，选取2009年1月—2015年6月因动静脉内瘘血栓形成而住院治疗的100例透析患者为病例组；同期行动静脉内瘘成形术且未发生内瘘血栓形成透析患者100例为对照组。收集相关临床及护理资料，分析各因素与动静脉内瘘血栓形成的关系，并针对性地进行护理措施改进。结果病例组的糖尿病患病率、穿刺失败率、血肿发生率、定点压迫力度过大、透析后包扎过紧和压迫止血时间〉30min发生率、超滤率和血红蛋白、高敏C-反应蛋白、空腹血糖、总胆固醇、低密度脂蛋白胆固醇、钙磷乘积及D-二聚体高于对照组，差异均有统计学意义（P〈0．05）；两组患者的收缩压、低分子肝素使用率比较，差异均有统计学意义（P〈0．05）；多因素Logistic回归分析结果显示，糖尿病[OR=1．417，95％CI（1．196—1．803），P=0．001]、穿刺失败[OR=1．393，95％CI（1．185-1．638），P=0．000]、透析后包扎过紧[OR=1．249，95％CI（1．101—1．416），P=0．001]、透析后压迫止血时间〉30min[OR=8．369，95％CI（1．725—40．596），P=0．008]、收缩压[OR=1．031，95％CI（1．001-1．061），P=0．040]、超滤率[OR=1．490，95％CI（1．146—1．937），P=0．003]、高敏C-反应蛋白[OR=1．594，95％CI（1．085-2．342），P=0．017]，低密度脂蛋白胆固醇[OR=9．456，95％CI（2．534—55．040），P=0．007]和D-二聚体[OR=11．711，95％CI（5．310—69．231），P=0．005]是维持性血液透析患者动静脉内瘘血栓形成的独立危险因素；低分子肝素使用[OR=0．101，95％CI（0．017-0．590），P=0．011]是其保护因素。结论维持性血液透析患者动静脉内瘘血栓形成除与自身代谢因素有关外，还与护理因素关系密切，应严格把握超滤率，提高穿刺成功率，加强�Objective To investigate the risk factors and improvement measures of thrombosis in internal arteriovenous fistula in maintenance hemodialysis patients. Methods Case control studies were performed in this study. Totals of 100 maintenance hemodialysis patients with thrombosis in internal arteriovenous fistula from January 2009 to June 2015 in Lishui Central Hospital were included in observation group, while another 100 patients with maintenance hemodialysis who did not have thrombosis in internal arteriovenous fistula were involved as control group. The related clinical and nursing data were collected, and the correlation between the thrombosis in internal arteriovenous fistula and related factors were analyzed to improve targeted nursing. Results Prevalence of diabetes, puncture failure rate, hematoma occurrence rate, high intensity in site-directed oppression, tightly binding after hemodialysis rate, oppression time longer than 30 min after hemodialysis rate, ultrafiltration rate, hemoglobin, high-sensitivity C-reactive protein, fasting blood glucose, total cholesterol, low density lipoprotein cholesterol, calcium-phosphorus product and D-dimer in observation group were higher than those in control group. The differences were statistically significant （ P 〈 0. 05 ）. There were statistically significant differences in the systolic pressure and low molecular weight heparin usage between two groups （P 〈0. 05）. The multi-factor logistic regression analysis showed that the diabetes[ OR = 1. 417, 95%CI （1. 196 - 1. 803）, P = 0. 001 ], puncture failure[ OR = 1. 393, 95% CI （1. 185 - 1. 638）, P = 0. 000], tightly binding after hemodialysis[ OR = 1. 249, 95% CI （ 1. 101 - 1. 416 ）, P = 0. 001 1, oppression time longer than 30 min after hemodialysis [ OR = 8. 369, 95% CI （ 1. 725 - 40. 596 ）, P = 0. 008 ], systolic pressure[ OR = 1. 031, 95% CI （ 1. 001 - 1. 061 ）, P = 0. 040 ], uhrafiltration rate [ OR = 1. 490, 95% CI （ 1. 146 - 1： 937）, P = 0. 003 ], high-sensitivity C-reactive pro

关 键 词：动静脉内瘘 血栓 影响因素 

分 类 号：R473.5[医药卫生—护理学]