血液透析患者内瘘失功原因及内瘘成熟时间的横断面调查研究  

Cross-Sectional Study on Causes of Internal Fistula Failure and Maturation Time of Internal Fistula in Hemodialysis Patients

作　　者：王宝福[1] 谢席胜[1] 冯胜刚[1] 林昌伟[1] 夏梦迪[1] 王彦江[1] 陈秋宏 

机构地区：[1]川北医学院第二临床学院(南充市中心医院)肾内科,四川 南充 [2]川北医学院第二临床学院,四川 南充

出　　处：《临床医学进展》2020年第9期2002-2008,共7页Advances in Clinical Medicine

摘　　要：目的:调查市县级医院维持性血液透析患者病因、血管通路类型、内瘘失功的原因和内瘘成熟的时间。方法:收集市12家公立医院血液透析患者1640例的临床资料,包括年龄、性别、原发疾病、透析龄、第一次通路的时间、第一次使用的时间、手术的单位、血管通路的类型、血管通路寿命、失功原因等。计量资料两组间比较采用单样本独立t检验,非正态分布计量资料采用非参数检验。计数资料的组间比较采用检验χ2或Finsher精确检验。对内瘘失功的相关因素及内瘘成熟和开始使用的最佳时间进行分析。结果:1640例维持性血液透析患者,青壮年占62.4%,1457例(88.8%)患者使用自体动静脉内瘘,5例(0.3%)使用聚四氟乙烯移植血管内瘘,178例(10.9%)使用带Cuff的中心静脉留置导管。透析患者原发性疾病主要为慢性肾炎、糖尿病肾病、高血压肾小动脉硬化症。158例内瘘失功患者中,因内瘘狭窄失功的患者125例(79.1%),因血容量不足失功的患者13例(8.2%);因血栓形成失功的患者20例(12.7%)。内瘘失功原因与内瘘成熟时间有统计学意义(χ2 = 29.881, P 【0.001),内瘘成熟时间及开始使用时间为61~90天时内瘘失功最少。结论:内瘘失功常见原因为内瘘狭窄、血容量不足和血栓形成,同时与内瘘成熟时间和内瘘开始使用时间有关,因此在透析过程中需要尽量术后61~90天时才开始进行穿刺透析,在长期透析过程中需要预防血容量不足和血栓形成,对于内瘘使用时间长的病人更要密切监测内瘘狭窄情况,提前进行干预。Objective: To investigate the etiology, vascular access type, the cause of internal fistula failure and the mature time of internal fistula. Methods: The clinical data of 1640 hemodialysis patients in 12 public hospitals were collected, including age, sex, primary disease, age of dialysis, time of first access, time of first use, unit of operation, type of access, life span of access, cause of failure, etc. Single sample independent t-test was used to compare the measurement data between the two groups, and nonparametric test was used to test the measurement data of non-normal distribution. The inter group comparison of counting data was performed by x2 or finsher test. The factors related to the loss of internal fistula and the best time for the fistula to mature and start to use were analyzed. Results: in 1640 patients with maintenance hemodialysis, 62.4% of them were young and middle-aged, 1457 (88.8%) used autogenous arteriovenous fistula, 5 (0.3%) used teflon to transplant arteriovenous fistula, 178 (10.9%) used central venous catheter with cuff. The main diseases of dialysis patients are chronic nephritis, diabetic nephropathy, hypertension and arteriosclerosis. Among 158 cases of internal fistula failure, 125 cases (79.1%) were due to internal fistula stenosis, 13 cases (8.2%) due to insufficient blood volume, and 20 cases (12.7%) due to thrombosis. There was a statistical significance between the cause of internal fistula failure and the mature time of internal fistula (x2= 29.881, P

关 键 词：血管通路 血液透析 动静脉瘘 

分 类 号：R47[医药卫生—护理学]