MHD治疗CRF患者发生AVF失功诱导因素及预防策略  

Induction Factors and Prevention Strategies of AVF Loss in Patients With CRF Treated by MHD

作　　者：欧阳奋竞 罗红梅 朱建强 OUYANG Fenjing;LUO Hongmei;ZHU Jianqiang(Department of Nephrology,Lianzhou People's Hospital,Lianzhou Guangdong 513400,China)

机构地区：[1]连州市人民医院肾内科,广东连州513400

出　　处：《中国卫生标准管理》2024年第21期117-120,124,共5页China Health Standard Management

基　　金：清远市社会发展领域自筹经费科技计划项目(211125124560814)。

摘　　要：目的分析行维持性血液透析(maintenance hemodialysis,MHD)治疗慢性肾衰竭(chronic renal faiure,CRF)患者发生动静脉内瘘(autologous arteriovenous fistula,AVF)失功的诱导因素,并提出预防策略。方法选取连州市人民医院2021年3月—2023年3月肾内科收治的行MHD治疗CRF患者200例,依据是否发生AVF失功,将其分为发生组(30例)和未发生组(170例),对2组患者一般资料进行单因素及多因素logistic回归分析,并提出预防性策略。结果单因素分析发现年龄、低血压、血浆白蛋白水平、抗凝药物、血小板计数、前臂动静脉内径、AVF狭窄、透析血流量、血磷水平与发生AVF失功有关(P<0.05)。多因素分析发现年龄>60岁、存在低血压、血浆白蛋白水平<35 g/L、抗凝药物为普通肝素、血小板计数>200×10^(9)/L、前臂动静脉内径≤2 mm、AVF狭窄、透析血流量≤200 mL/min、血磷>2.5 mmol/L是CRF患者发生AVF失功的诱导因素(P<0.05)。结论存在上述诱导因素的CRF患者发生AVF失功的风险性较大,肾内科临床医师应引起重视。本研究结果为CRF患者发生AVF失功诱导因素后期标准制订提供了借鉴内容。Objective To analyze the induced factors of loss of autologous arteriovenous fistula(AVF)in patients with chronic renal failure(CRF)treated by maintenance hemodialysis(MHD),and to propose preventive strategies.Methods A total of 200 patients with CRF treated with MHD were selected from department of nephrology,Lianzhou People's Hospital from March 2021 to March 2023.According to whether AVF loss occurred,they were divided into occurrence group(30 cases)and non-occurrence group(170 cases).Univariate and multivariate logistic regression analysis was performed on the general data of the two groups.And put forward the preventive strategy.Results Univariate analysis showed that age,hypotension,plasma albumin level,anticoagulation medicine,platelet count,forearm arteriovenous diameter,AVF stenosis,dialysis blood flow and blood phosphorus level were related to AVF loss(P<0.05).The logistic analysis showed that AVF loss occurred in CRF patients with age>60 years old,hypotension,plasma albumin level<35 g/L,anticoagulation medicine using ordinary heparin,platelet count>200×10^(9)/L,forearm arteriovenous diameter≤2 mm,AVF stenosis,dialysis blood flow≤200 mL/min,and blood phosphorus>2.5 mmol/L(P<0.05).Conclusion The risk of AVF loss is greater in CRF patients with the above inducement factors,which should be paid attention to by renal clinicians.The results of this study provide references for the formulation of criteria for the induction factors of AVF loss in CRF patients.

关 键 词：维持性血液透析 慢性肾衰竭 动静脉内瘘 诱导因素 LOGISTIC回归分析 预防策略 

分 类 号：R692[医药卫生—泌尿科学]