维持性血液透析患者自体动静脉内瘘使用时间及其影响因素研究  

Service Life and Risk Factors of Autogenous Arteriovenous Fistulas for Maintenance Hemodialysis

作　　者：王博[1] 魏芳[1] 孙桂江[1] 陈海燕[1] 卢志[1] 贾岚 姜埃利[1] WANG Bo;WEI Fang;SUN Guijiang;CHEN Haiyan;LU Zhi;JIA Lan;JIANG Aili(Department of Kidney Disease and Blood Purification,the Second Hospital of Tianjin Medical University,Tianjin 300211,China)

机构地区：[1]天津医科大学第二医院肾脏疾病与血液净化科,天津市300211

出　　处：《中国全科医学》2018年第29期3577-3581,共5页Chinese General Practice

基　　金：国家自然科学基金资助项目(81600591)

摘　　要：目的探讨维持性血液透析患者自体动静脉内瘘(AVF)使用时间及其影响因素。方法选取2010—2011年天津医科大学第二医院初次行AVF手术的患者126例,从数字化管理系统中获取患者AVF自建立之初至5年末的临床资料,根据AVF使用情况分为AVF丧失功能组(61例)与AVF通畅组(65例),采用Kaplan-Meier方法绘制生存曲线,采用多因素Cox比例风险回归模型分析AVF使用时间的影响因素。结果 126例患者AVF 1年使用率为92.1%,3年使用率为69.8%,5年使用率为51.6%。AVF丧失功能组与AVF通畅组患者糖尿病检出率、血液透析中低血压(IDH)发生率、血磷水平比较,差异均有统计学意义(P<0.05)。多因素Cox比例风险回归分析结果显示,糖尿病[HR=2.187,95%CI(1.303,3.670)]、IDH[HR=1.703,95%CI(1.004,2.888)]、高磷血症[HR=1.893,95%CI(1.295,2.766)]与AVF使用时间有回归关系(P<0.05)。结论维持性血液透析患者AVF使用时间较短,糖尿病、IDH、高磷血症发生是缩短AVF使用时间的危险因素。Objective To explore the survival time and risk factors of autogenous arteriovenous fistula(AVF)for maintenance hemodialysis.Methods A cohort study regarding 126 cases who underwent AVF creation in the Second Hospital of Tianjin Medical University for the first time from 2010 to 2011 was conducted.The clinical data of them from the creation of AVF to five years later were obtained from the hemodialysis patients database of the hospital.According to the functional patency of AVF,they were divided into nonfunctional AVF group(n=61)and functional AVF group(n=65).Kaplan-Meier survival curves and multivariate Cox proportional hazard models were used to determine the service life of AVF and associated factors,respectively.Results The rate of AVF survival at 1 year,3 years,5 years after AVF creation for all the participants was 92.1%,69.8%,51.6%,respectively.The prevalence of diabetes,incidence of intradialytic hypotension(IDH)and mean serum phosphorus level differed significantly between the functional and nonfunctional AVF groups(P<0.05).Multivariate Cox proportional hazard regression analysis showed that diabetes〔HR=2.187,95%CI(1.303,3.670)〕,IDH〔HR=1.703,95%CI(1.004,2.888)〕and hyperphosphatemia〔HR=1.893,95%CI(1.295,2.766)〕were risk factors for the service life of AVF(P<0.05).Conclusion The service life of AVF among maintenance hemodialysis patients is short,and the risk factors associated with it included diabetes,IDH and hyperphosphatemia.

关 键 词：肾透析 动静脉瘘 影响因素分析 

分 类 号：R459.52[医药卫生—治疗学]