维持性血液透析患者自体动静脉内瘘失功的相关因素分析

Analysis of the factors relating to the dysfunction in autogenous arteriovenous fistula in maintenance hemodialysis patients

目的探讨维持性血液透析(HD)患者自体动静脉内瘘(AVF)失功的相关因素。方法回顾性分析AVF行HD的225例患者,透析时间为3～60个月,根据AVF是否失功分成通畅组和失功组,观察两组患者的综合情况(年龄、性别、原发病、血压、高凝倾向)和AVF的各项指标(血栓形成、内瘘狭窄、血流量、压迫时间、穿刺方法、使用时间、血肿)对AVF失功的影响。结果 225例患者中有43例(占19.11%)失功;失功组的平均年龄高于通畅组(P<0.01);通畅组和失功组在血栓形成、内瘘狭窄、原发病是否为糖尿病肾病、发生血肿、低血压、高凝倾向、穿刺点压迫时间、血流量以及穿刺方法等指标方面差异均有统计学意义(P<0.05)。结论年龄、血栓形成、内瘘狭窄、糖尿病肾病、压迫时间、内瘘血肿、低血压、低血流量、高凝倾向及纽扣式穿刺法是影响AVF失功的重要因素。

Objective Retrospective analysis of the factors relating to the dysfunction of autogenous arteriovenous fistula（AVF） in maintenance hemodialysis（HD） patients.Methods A total of 225 maintenance HD patients who received hemodialysis for 3-60 months in autogenous AVF were analyzed retrospectively,and these patients were divided into unobstructed group and dysfunction group.The general conditions such as age,sex,primary disease,BP,hypercoagulability and indexes of AVF such as thrombosis,vascular stenosis,blood flow,pressing time,puncture method,using time and hematoma that relate to the dysfunction of AVF were observed in these patients.Results Dysfunction in AVF was found in 43（19.11%） patients.The mean age of patients in dysfunction group was older than that in unobstructed group（P0.01）.Thrombosis,vascular stenosis,diabetic nephropathy,hematoma,hypotension,hypercoagulability,pressure time at the puncture sites,blood flow and puncture method were significantly different between patients with unobstructed group and dysfunction group（P0.05）.Conclusion Age,thrombosis,vascular stenosis,diabetic nephropathy,pressure time,hematoma,hypotension,low blood flow,hypercoagulability and button puncture method are important factors relating to dysfunction in AVF in maintenance HD.