血液透析患者自体动静脉内瘘早期失功的相关因素研究  

Study on the correlative factors of early work-loss in patients with autologous arteriovenous fistula in hemodialysis

作　　者：殷效龙 叶建华[1] 张汀[1] 陈孟华[1] YIN Xiaolong;YE Jianhua;ZHANG Ting;CHEN Menghua(Department of Nephrology,General Hospital of Ningxia Medical University,Yinchuan 750004,China)

机构地区：[1]宁夏医科大学总医院肾脏内科,宁夏银川750004

出　　处：《宁夏医学杂志》2024年第1期12-15,共4页Ningxia Medical Journal

摘　　要：目的 探讨血液透析患者自体动静脉内瘘(AVF)早期失功的相关危险因素,为降低自体动静脉内瘘失功的发生提供依据。方法 选择收治的拟行血液透析首次建立自体动静脉内瘘手术的92例患者,根据术后1个月,未行透析前是否发生自体动静脉内瘘早期失功分成通畅组(n=45)和失功组(n=47),收集2组临床资料,采用多因素分析法分析自体动静脉内瘘早期失功的独立危险因素。结果 与AVF通畅组比较,失功组患者血肌酐水平,术者工作年限<3年和术后未使用抗凝药物,术前舒张压、术后收缩压和舒张压均高于通畅组,而血清白蛋白、血红蛋白水平较低(P<0.05)。单因素Cox回归分析显示,患者术后未使用抗凝药物、血肌酐水平、血清白蛋白、血红蛋白、术前舒张压、术后收缩压和舒张压是血液透析病人自体动静脉内瘘早期失功的危险因素(P<0.05)。多因素Cox回归分析显示,术后未使用抗凝药物和术后收缩压是血液透析病人自体动静脉内瘘早期失功的独立危险因素(P<0.05)。结论 提高AVF手术技能,管理好慢性肾脏病患者血压和营养状态,术后及时使用抗凝药物,有助于减少AVF失功的发生。Objective[HJ2mm]To explore the risk factors for early failure of autologous arteriovenous fistula(AVF)in hemodialysis patients in order to provide a basis for reducing the occurrence of dysfunction of AVF.Methods 92 patients undergoing hemodialysis for the first time to establish AVF were enrolled.The patients were divided into AVF patency group(n=45)and AVF failure group(n=47)according to one month after surgery,before dialysis and AVF function.The clinical data were collected and the independent risk factors for early AVF failure were analyzed by multiple factor analysis method.Results Compared with the AVF patency group,blood creatinine,operator′s working experience was less than 3 years,no use anticoagulants after surgery,preoperative diastolic blood pressure,postoperative systolic and diastolic blood pressure were higher,while albumin and hemoglobin were lower in AVF failure Group(P<0.05).Single factor Cox regression analysis showed that the operator′s working experience was less than three years,no use anticoagulants after surgery,serum creatinine,albumin,hemoglobin,preoperative diastolic blood pressure,postoperative systolic and diastolic blood pressure were risk factors for early AVF failure in hemodialysis patients(P<0.05).Multivariate Cox regression analysis showed that no use anticoagulants after surgery and postoperative systolic blood pressure were independent risk factors for early AVF failure in hemodialysis patients(P<0.05).Conclusion In clinical work,to improve AVF surgical skills,manage the blood pressure and nutritional status of patients with chronic kidney disease,timely use of anticoagulants after surgery can reduce the occurrence of AVF dysfunction.

关 键 词：血液透析 自体动静脉内瘘 早期失功 危险因素 

分 类 号：R556[医药卫生—血液循环系统疾病]