新建自体动静脉内瘘手术早期失功原因分析及护理  

Early failure of arteriovenous fistula and its related factors and nursing

作　　者：卢文文[1] 曹艳佩 杨晓莉 黄碧红[3] 王欣 Lu Wenwen;Cao Yanpei;Yang Xiaoli;Huang Bihong;Wang Xin(Nursing Department,Huashan Hospital Affiliated to Fudan University,Shanghai 200040,China)

机构地区：[1]复旦大学护理学院,上海200030 [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：《中国实用护理杂志》2018年第31期2418-2422,共5页Chinese Journal of Practical Nursing

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

摘　　要：目的调查行新建自体动静脉内瘘（AVF）术的终末期肾病（ESRD）患者内瘘早期功能失败（失功）情况，分析内瘘早期失功影响因素，为临床早期干预和进行护理提供参考依据。方法本研究为回顾性研究。通过医院患者管理软件系统和电话随访，调查成功行新建AVF成形术88例患者资料。统计患者基本资料、合并疾病、术前评估方法和内瘘早期失功等情况，筛查内瘘早期失功危险因素。结果共纳人88例患者，早期失功15例。性别等23个因素参与统计分析，成功组与失功组合并高血压（r=7．689，P=0．006）和是否早期向肾内科转诊（r=5．334，P=0．021）比较差异有统计学意义。进一步回归分析，未早期转诊（OR=3．651，95％CI 1．068-18．302，P=0．039）是内瘘早期失功危险性因素，合并高血压（OR=0．192，95％CI 0．054-0．692，P=0．012）是内瘘早期失功保护性因素。结论本研究表明未早期向‘肾内科转诊和合并高血压是影响内瘘早期失功的重要因素，强调临床工作中，对于确诊的慢性肾脏病患者，应早期建立。肾内科转诊，同时应做好患者血压监测和管理，有利于降低内瘘早期失功发生率。Objective The aim of the study was to investigate the early failure of newly created arteriovenous fistula（AVF） in patients on maintenance hemodialysis and the factors responsible for the failure. Methods The clinical data were retrospectively reviewed, preoperative examination and laboratory biochemical indicators of 88 patients with newly created AVF for maintenance hemodialysis in our hospital through Hospital Management Information System and telephone follow-ups. Binary Logistic regression was used to analyze the protective factors for early failure. Results In 88 patients, early failure of the AVF was found in 15 patients. Twenty-three factors, including gender, were involved in statistical analysis. There were statistical differences between the two groups in hypertension （x^2=7.689, P= 0.006） and whether they had early referral to nephrologists （X2=5.334, P=0.021）. Further regression analysis showed hypertension （OR=0.192, 95% CI=0.0538-0.692, P=0.O12） was protective factor and without early referral （OR=3.651, 95% CI=1.068- 18.302, P=0.039） was the risk factor of early failure. Conclusion This study shows that no early referral and combined hypertension is an important factor affecting the early failure, emphasizing the clinical work, for the diagnosis of patients with chronic kidney disease, early nephrological referral should be established, and blood pressure monitoring should be done to help reduce the incidence of complications.

关 键 词：肾透析 自体动静脉内瘘 导管失功 

分 类 号：R473.6[医药卫生—护理学]