探讨维持性血液透析患者动静脉内瘘血栓形成的影响因素

Exploring the Influencing Factors of Arteriovenous Fistula Thrombosis in Maintenance Hemodialysis Patients

目的分析维持性血液透析(MHD)患者动静脉内瘘(AVF)血栓形成的影响因素。方法回顾2016年10月—2019年10月在该院接受血液透析治疗出现内瘘流量不足或闭塞的62例患者临床资料,统计AVF血栓形成情况,并分析其影响因素。结果 62例患者中共计48例形成血栓,发生率为77.42%。血栓形成组患者发生低血压发生率58.33%、合并糖尿病发生率45.83%情况均高于无血栓形成组的28.57%、14.29%(χ^2=3.844、4.546,P<0.05);血栓形成组的年龄(62.28±6.72)岁、ALB(30.82±4.24)g/L、CRP(25.38±3.08)mg/L、Fib(5.72±1.45)g/L等指标与无血栓形成组(56.89±6.68)岁、(35.47±5.10)g/L、(19.04±1.44)mg/L、(4.82±1.26)g/L,对比差异有统计学意义(t=2.644、3.447、7.435、2.099,P<0.05)。多因素分析显示,合并糖尿病、CRP、Fib是导致MHD患者AVF血栓形成的独立危险因素,(OR=2.940、3.168、2.988,P<0.05)。结论由于多种原因,维持性血液透析患者易形成血栓,而血栓可能导致动静脉内瘘失功,因此对于合并存在糖尿病、炎症、纤维蛋白原增高情况的患者应当积极干预,预防血栓形成。

Objective To analyze the influencing factors of arteriovenous fistula(AVF) thrombosis in maintenance hemodialysis(MHD) patients. Methods To review the clinical data of 62 patients with insufficient flow or occlusion of internal fistula who underwent hemodialysis in the hospital from October 2016 to October 2019. The AVF thrombosis was counted and its influencing factors were analyzed. Results A total of 48 of the 62 patients formed thrombosis, and the incidence was 77.42%. The incidence of hypotension in the thrombosis group was 58.33%, and the incidence of diabetes mellitus was 45.83%, which were higher than those in the non-thrombosis group, 28.57% and 14.29%(χ^2=3.844,4.546, P<0.05);Age(62.28±6.72) years old, ALB(30.82±4.24) g/L, CRP(25.38±3.08) mg/L, Fib(5.72±1.45) g/L and other indicators and non-thrombosis group(56.89±6.68) years old,(35.47±5.10)g/L,(19.04±1.44)mg/L,(4.82±1.26)g/L,the difference was statistically significant(t =2.644, 3.447, 7.435, 2.099, P <0.05). Multivariate analysis showed that combined diabetes, CRP, and Fib were independent risk factors for AVF thrombosis in MHD patients(OR=2.940, 3.168,2.988, P <0.05). Conclusion Due to many reasons, maintenance hemodialysis patients are prone to thrombosis, and thrombosis may cause failure of arteriovenous fistula. Therefore, patients with diabetes, inflammation, and increased fibrinogen should actively intervene to prevent thrombosis.