472例自体动静脉内瘘的生存分析和影响因素  

Survival analysis and risk factors for arteriovenous fistula in 472 patients

作　　者：周乐天[1] 刘虹[1] 刘伏友[1] 吴鸿[1] 张磊[1] 李峥[1] 李军[1] 

机构地区：[1]中南大学湘雅二医院肾内科,长沙410011

出　　处：《中南大学学报（医学版）》2015年第8期902-906,共5页Journal of Central South University ：Medical Science

摘　　要：目的:了解血液透析患者自体动静脉内瘘的使用寿命,探讨影响血液透析患者自体动静脉内瘘的相关因素。方法:回顾性分析2009年于中南大学湘雅二医院肾内科进行第一次自体动静脉内瘘手术的472例患者,记录内瘘使用情况、并发症及各种影响因素。采用Kaplan-Meier法绘制生存曲线,并用COX模型进行多元回归分析,以确定其相关因素。结果:至2014年1月1日止,除不确定内瘘结局的患者(失访72例,死亡101例,肾移植44例)外,内瘘的初级失败率为10.9%,1年生存率为80.5%,3年生存率为65.1%,5年生存率为50.5%。自体动静脉内瘘的并发症发生率为39.8%,因此而发生的住院率为9.8%。成熟内瘘使用寿命的影响因素包括舒张压(HR:0.86,95%CI:0.82~0.89)、糖尿病(HR:1.87,95%CI:1.32~3.31)、血清白蛋白水平(HR:0.83,95%CI:0.74~0.94)。结论:在进行内瘘手术前应考虑到可能发生的并发症,低血压、糖尿病、低白蛋白血症是降低内瘘使用寿命的主要危险因素。Objective: To evaluate the service life ofthe arteriovenous fistula(AVF) in patients with dialysis and to explore the associated factors for AVF service life.Methods: A cohort study regarding 472 cases with AVFs at the Second Xiangya Hospital from January 2009 to December 2009 was retrospectively analyzed. The AVF placement-associated primary and secondary failure rates, complications and various risk factors were examined. Kaplan–Meier survival curves and Cox proportional hazard models were used to determine the service life and associated factors.Results: By the end ofJanuary 1st, 2014, after excluding the patients with indeterminate outcome(72 lost to follow-up; 101 died; 44 transplanted), the primary failure rate was 10.9%, the survival rate for 1, 3 or 5 years was 80.5%, 65.1% or 50.5%. The complication rate and hospitalization rate for AVF were 39.8% and 9.8%, respectively. The influential factors for AVF were diastolic hypotension(HR: 0.86; 95% CI: 0.82 to 0.89), diabetes(HR: 1.87; 95% CI: 1.32 to 3.31) and serum albumin(HR: 0.83; 95% CI: 0.74 to 0.94).Conclusion: The complications after AVF placement must be considered before the surgery schedule. Hypotension, diabetes and serum albumin are the main risk factors for AVF service life.

关 键 词：自体动静脉内瘘 维持性血液透析 初级失败 次级失败 并发症 

分 类 号：R473.6[医药卫生—护理学]