维持性血液透析患者动静脉内瘘失功的原因分析及对策探讨

An analysis of the causes of arteriovenous fistula dysfunction in maintenance hemodialysis patients and an exploration of the countermeasures

目的探讨维持性血液透析患者动静脉内瘘失功的原因分析及对策。方法本研究通过整群抽样方式随机抽取2018年1月~2019年8月在我院接受维持性血液透析治疗的患者160例,其中未出现静脉内瘘失功的139例患者设为对照组,出现静脉内瘘失功的21例患者设为研究组,分析部分发生内瘘狭窄或闭塞患者的临床资料,找出内瘘失功的原因,提出相应的护理措施。结果单因素分析结果提示,影响动静脉内瘘失功的原因为内瘘狭窄、低血压、感染、穿刺方式以及压迫时间等;经多因素Logistic回归分析,显示血栓形成、内瘘狭窄、内瘘血肿、感染、低血压以及压迫时间≥30min是动脉静脉瘘失功的危险因素。结论对动静脉内瘘失功的原因进行分析并制定出合理的护理措施,可有效降低临床干预风险发生的可能性,确保血液透析顺利进行,临床可推广使用。

Objective To explore the analysis of the causes of arteriovenous fistula dysfunction in maintenance hemodialysis patients and the countermeasures.Methods 160 patients undergoing maintenance hemodialysis in our hospital from January 2018 to August 2019 were randomly selected by cluster sampling for this study.Among them,139 patients who did not suffer from venous fistula dysfunction were set as the control group,and 21 patients who suffered from venous fistula dysfunction were set as the study group.The clinical data of some patients with stenosis or occlusion of internal fistula were analyzed for finding out the causes of internal fistula dysfunction and putting forward corresponding nursing measures.Results The results of single-factor analysis showed that the causes of arteriovenous fistula dysfunction were stenosis of internal fistula,hypotension,infection,puncture method and compression time,etc.Multivariate Logistic regression analysis showed that thrombosis,internal fistula stenosis,internal fistula hematoma,infection,hypotension and compression time≥30 min were risk factors for arteriovenous fistula loss.Conclusion Analyzing the causes of arteriovenous fistula dysfunction and formulating reasonable nursing measures can effectively reduce the possibility of clinical intervention risks andguarantee the smooth progress of hemodialysis.It can be promoted in clinical practicefor more application.