维持性血液透析患者认知障碍与动静脉内瘘血栓事件的相关性研究  

Study on the Correlation Between Cognitive Impairment and Arteriovenous Fistula Thrombosis in Maintenance Hemodialysis Patients

作　　者：傅丽丽 万静芳 李丹 向杨 罗佳 李云姝 FU Lili;WAN Jingfang;LI Dan;XIANG Yang;LUO Jia;LI Yunshu(Blood Purification Center,Department of Nephrology,Army Specialty Medical Center,Chongqing 400042,China)

机构地区：[1]陆军特色医学中心肾内科血净中心,重庆400042

出　　处：《联勤军事医学》2024年第3期228-232,共5页Military Medicine of Joint Logistics

基　　金：重庆市技术创新与应用发展专项面上项目(cstc2019jscx-msxmX0212)。

摘　　要：目的探讨维持性血液透析(maintenance hemodialysis,MHD)患者认知水平与动静脉内瘘血栓事件发生的关系。方法选取2020-01/2022-12月在作者医院行MHD的180例患者作为研究对象。调查MHD患者临床资料、动静脉内瘘血栓事件发生情况、认知功能评分。根据蒙特利尔认知评估基础量表(montreal cognitive assessment-basic,MoCA-B)中文版认知评分将患者分为认知功能正常组(n=92)和认知功能障碍组(n=88)。分析MHD患者认知功能评分与动静脉内瘘血栓事件发生的相关性,采用Logistic回归分析探讨影响动静脉内瘘血栓事件的相关因素。结果认知功能障碍组MHD患者年龄、合并糖尿病患者比例、动静脉内瘘血栓事件发生次数高于认知功能正常组,血清白蛋白水平低于认知功能正常组,差异有统计学意义(P均<0.05)。认知功能障碍组MHD患者动静脉内瘘血栓事件发生率明显高于认知功能正常组(P=0.013)。MHD患者认知障碍评估得分与动静脉内瘘血栓事件发生呈负相关关系(r=-0.175,P=0.019),与患者认知受损领域呈负相关关系(r=-0.916,P<0.001);患者动静脉内瘘血栓事件发生与患者认知受损领域呈正相关关系(r=0.189,P=0.011)。Logistic多因素回顾分析结果显示,认知功能正常MHD患者较认知功能障碍MHD患者发生内瘘血栓事件风险更低(OR=0.385,P=0.044),男性较女性MHD患者发生内瘘血栓事件的风险更低(OR=0.363,P=0.039),血红蛋白是MHD患者内瘘血栓事件发生的独立危险因素(OR=1.035,P=0.039)。结论MHD患者认知障碍发生率较高,认知障碍会影响患者动静脉内瘘血栓事件发生,认知障碍程度越严重,患者动静脉内瘘血栓事件发生率越高。临床需要对伴随认知障碍的女性、高血红蛋白血症MHD患者予以重点关注,同时加强对MHD患者认知功能障碍的筛查,早期识别并采取针对性干预措施,对减少动静脉内瘘血栓事件的发生,延长MHD患者内瘘的使用寿�Objective To explore the relationship between cognitive level and occurrence of arteriovenous fistula throm-bosis in maintenance hemodialysis(MHD)patients.Methods A total of 180 patients undergoing MHD in author's hospital from January 2020 to December 2022 were selected.The clinical data,incidence of arteriovenous fistula thrombosis and cognitive function score of the MHD patients were investigated.The patients were divided into normal cognitive function group(n=92)and cognitive impairment group(n=88)according to the cognitive scores of the Chinese version of the montreal cognitive assess-ment-basic(MoCA-B).The correlation between cognitive function scores and the occurrence of arteriovenous fistula throm-bosis of MHD patients was analyzed,the related factors affecting arteriovenous fistula thrombosis were analyzed by Logis-tic regression analysis.Results The age,the proportion of patients with diabetes mellitus and the number of arteriove-nous fistula thrombosis of MHD patients in the cognitive impairment group were higher than those in the normal cognitive function group,serum albumin was lower than that of the normal cognitive function group,and the difference was statisti-cally significant(all P<0.05).The incidence of arteriovenous fistula thrombosis in MHD patients with cognitive im-pairment was significantly higher than that in MHD patients with normal cognitive function(P=0.013).Cognitive im-pairment assessment scores of MHD patients were negatively correlated with arteriovenous fistula thrombosis(r=-0.175,P=0.019),and negatively correlated with number of impaired domains in cognitive function(r=-0.916,P<0.001);there was a positive correla-tion between arteriovenous fistula thrombosis and number of impaired domains in cognitive function(r=0.189,P=0.011).Logistic multivariate regression analysis showed that MHD patients with normal cognitive function had a low-er risk of arteriovenous fistula thrombosis than MHD patients with cognitive impairment(OR=0.385,P=0.044),male MHD patients had a lower risk of arte

关 键 词：认知障碍 维持性血液透析 动静脉内瘘血栓 相关性 

分 类 号：R749.1[医药卫生—神经病学与精神病学]