维持性血液透析患者体力活动对自体动静脉内瘘血栓形成的影响  

Effect of physical activity on arteriovenous fistula thrombosis in patients taking maintenance hemodialysis

作　　者：赵宜娜 黄惠根 李彩霞[1] 宋利 周丽芳 杜真萍 蔡少娜 符霞[1,3] Zhao Yina;Huang Huigen;Li Caixia;Song Li;Zhou Lifang;Du Zhenping;Cai Shaona;Fu Xia(Nursing Department,Eighth Affiliated Hospital,Sun Yat-sen University,Shenzhen 518033,China;Department of Nephrology,Guangdong Provincial People's Hospital,Southern Medical University,Guangdong Academy of Medical Sciences,Guangzhou 515063,China;School of Nursing,Guangdong Pharmaceutical University,Guangzhou 510006,China)

机构地区：[1]中山大学附属第八医院护理部,深圳518033 [2]南方医科大学附属广东省人民医院广东省医学科学院肾内科,广州515063 [3]广东药科大学护理学院,广州510006

出　　处：《国际医药卫生导报》2025年第4期650-657,共8页International Medicine and Health Guidance News

基　　金：2023年度广东省卫生健康适宜技术推广项目(B-2023-681);广东省岭南南丁格尔护理研究院、广东省护理学会2023年度护理创新发展研究课题(YJYZ202303);福田区卫生健康系统科研项目(FTWS2023087)。

摘　　要：目的明确维持性血液透析(MHD)患者体力活动对自体动静脉内瘘(AVF)血栓形成的影响,为内瘘管理提供新策略。方法采用便利抽样方法,对2021年10月至12月在广东省人民医院治疗的274例MHD患者体力活动水平进行调查,并以AVF是否发生血栓分为血栓组(31例)和非血栓组(243例)。血栓组男20例、女11例,年龄(56.19±12.77)岁;非血栓组男157例、女86例,年龄(57.55±14.04)岁。以AVF血栓形成为主要终点事件对MHD患者进行随访,截止时间为2022年12月31日。采用t检验、χ^(2)检验、方差分析比较组间差异,采用Cox比例风险回归模型和限制性立方样条评估体力活动对AVF血栓形成的影响。结果两组患者基础资料比较,差异均无统计学意义(均P>0.05)。血栓组既往功能不良占比高于非血栓组[58.1%(18/31)比26.3%(64/243)],差异有统计学意义(χ^(2)=13.197,P<0.01)。274例患者中,体力活动不足有85例(31.0%)、体力活动适中有116例(42.4%)、体力活动活跃有73例(26.6%)。Cox比例风险模型显示,体力活动活跃是AVF血栓形成的影响因素(HR=0.274,95%CI 0.097~0.711,P=0.014)。限制性立方样条显示,体力活动与内瘘血栓形成风险之间的剂量-反应关系,差异无统计学意义(χ^(2)=4.960,P_(nonlinear)=0.084)。结论与体力活动不足相比,体力活动活跃可以降低AVF血栓形成,提高患者体力活动水平,降低AVF血栓形成。Objective To determine the impact of physical activity on the arteriovenous fistula(AVF)thrombosis in patients taking maintenance hemodialysis(MHD),and to provide new strategies for the management of fistula.Methods The convenient sampling method was used.The physical activity of 274 patients taking MHD at Guangdong Provincial People's Hospital from October to December 2021 were investigated.According to whether the patients had AVF thrombosis,they were divided into a thrombosis group(31 cases)and a non-thrombosis group(243 cases).There were 20 males and 11 females in the thrombosis group;they were(56.19±12.77)years old.There were 157 males and 86 females in the non-thrombosis group;they were(57.55±14.04)years old.The patients were followed up with AVF thrombosis as the primary endpoint until December 31,2022.t test,χ^(2)test,and analysis of variance were used to compare the differences between the two groups.The Cox proportional hazard regression model and restricted cubic splines were used to assess the effect of physical activity on AVF thrombosis.Results There were no statistical differences in the basic data between the two groups(all P>0.05).The proportion of the patients with dysfunction history in the thrombosis group was higher than that in the non-thrombosis group[58.1%(18/31)vs.26.3%(64/243)],with a statistical difference(χ^(2)=13.197,P<0.01).Among the 274 patients,85(31.0%)had insufficient physical activity,116(42.4%)moderate physical activity,and 73(26.6%)active physical activity.The Cox proportional risk model showed that physical activity was a factor affecting AVF thrombosis(HR=0.274,95%CI 0.097-0.711,P=0.014).The limited cubic spline showed that the nonlinear relationship between physical activity and thrombosis was not significant(χ^(2)=4.960,P_(nonlinear)=0.084).Conclusion Compared with insufficient physical activity,active physical activity can reduce AVF thrombosis,suggesting that medical personnel can reduce the formation of AVF thrombosis increasing patients'physical activity.

关 键 词：维持性血液透析 体力活动 动静脉内瘘 血栓 

分 类 号：R54[医药卫生—心血管疾病]