血液透析患者自体动静脉内瘘并发症的影响因素分析  

Risk factors for arteriovenous fistula complications in hemodialysis patients

作　　者：任崇[1] 曹艳佩 杨晓莉 黄碧红[3] 卢文文[1] 

机构地区：[1]复旦大学护理学院,上海200040 [2]复旦大学附属华山医院护理部,上海200040 [3]复旦大学附属华山医院血液净化中心,上海200040

出　　处：《中国血液净化》2017年第9期631-634,共4页Chinese Journal of Blood Purification

基　　金：上海市卫生和计划生育委员会科研课题(编号:201640126);上海市卫生和计划生育委员会科研课题(编号:201540085);复旦大学校级课题(FNF201529)复旦大学校级课题(FNF201610)

摘　　要：目的探讨血液透析患者自体动静脉内瘘并发症的影响因素。方法选择2016年7月~2016年12月复旦大学附属华山医院血液净化中心通过自体动静脉内瘘进行维持性血液透析的患者89例,应用超声检测内瘘是否存在并发症(狭窄和血栓),记录临床及生化检查数据,并应用二元Logistic回归分析的方法探讨结局指标并发症的影响因素。结果超声显示72(80.9%)例内瘘结构正常,17(19.1%)例存在并发症。并发症组与非并发症组性别(t=9.108,P=0.003)、甲状旁腺素(t=-2.456,P=0.016)、白蛋白(t=3.297,P=0.001)、前白蛋白(t=2.068,P=0.042)差异有统计学意义(P<0.05),二元Logistic回归分析结果提示性别[OR=11.474,95%CI(2.388~56.311),P=0.003]为内瘘并发症发生的危险因素,白蛋白[OR=0.683,95%CI(0.493~0.947),P=0.022]为其保护因素。结论血液透析患者自体动静脉内瘘并发症的发生与性别、白蛋白水平相关,应增加对女性、低白蛋白患者内瘘的关注,加强健康宣教,预防并发症的发生。Objective To discuss the risk factors for arteriovenous fistula （AVF） complications in hemodialysis patients. Methods A total of 89 hemodialysis patients with AVF treated in the blood purification center from Ju1. 1, 2016 to Dec. 30, 2016 were recruited. AVF complications including stenosis and thrombosis were examined by color Doppler ultrasonography. Clinical and biochemical data were recorded. Risk factors for the complications were analyzed by logistic regression. Results Ultrasonography showed that 72 （80.9%） were normal in structure, and 17 （19.1%） had complication. There were significant differences in gen- der （t=9.108, P=0.003）, parathyroid hormone （t=-2.456, P=0.016）, albumin （t=-3.297, P=0.001） and pre-albu- min （t=2.068, P=0.042） between complication group and non-complication group. Logistic regression revealed that gender （OR=I 1.474, 95% CI 2.388-56.311, P=0.003） was the risk factor for AVF complications, while albumin （OR=0.683, 95% CI 0.493-0.947, P=0.022） was the protective factor. Conclusions The prevalence of AVF complications was related to gender and serum albumin. Therefore, special care should be paid to the female and hypoalbuminemia patients with AVF. Education to the patients is also useful for the prevention of AVF complications in hemodialysis patients.

关 键 词：血液透析 自体动静脉内瘘 并发症 

分 类 号：R318.16[医药卫生—生物医学工程]