自体动静脉内瘘失功的相关危险因素分析

Analysis of Risk Factors Related to Failure of Autologous Arteriovenous Fistula

目的:探讨自体动静脉内瘘(AVF)失功的相关危险因素及其防范措施。方法:回顾性分析2020年1月-2022年6月在萍乡矿业集团有限责任公司总医院与宜春市第三人民医院行AVF术的89例慢性肾衰竭患者临床资料,分析AVF失功的相关危险因素。结果:89例行AVF术治疗的慢性肾衰竭患者中发生AVF失功28例(31.46%)。单因素分析显示:AVF失功组年龄≥60岁、低血压、吸烟史、钙磷乘积≥55 mg^(2)/dL^(2)、糖尿病肾病、高脂血症、血清白蛋白水平<35 g/L的比例与非AVF失功组比较,差异均有统计学意义(P<0.05);两组性别、体重指数、内瘘使用时间比较,差异均无统计学意义(P>0.05)。多因素分析显示:年龄≥60岁[β=1.427,OR=4.167,95%CI(1.287,13.493)]、低血压[β=1.266,OR=3.548,95%CI(1.263,9.968)]、吸烟史[β=2.647,OR=14.107,95%CI(4.561,43.631)]、钙磷乘积≥55 mg^(2)/dL^(2)[β=1.159,OR=3.185,95%CI(1.258,8.064)]、糖尿病肾病[β=2.478,OR=11.922,95%CI(3.996,35.574)]、高脂血症[β=1.657,OR=5.245,95%CI(1.951,14.097)]、血清白蛋白水平<35 g/L[β=1.499,OR=4.476,95%CI(1.719,11.658)]均是AVF失功的高危因素(P<0.05)。结论:AVF失功发生与年龄、低血压、吸烟史、钙磷乘积、糖尿病肾病、高脂血症、血清白蛋白水平有关。

Objective:To investigate the related risk factors and preventive measures of failure of autogenous arteriovenous fistula(AVF).Method:The clinical data of 89 patients with chronic renal failure who underwent AVF in General Hospital of Pingxiang Mining Group Co.,LTD and the Third People's Hospital of Yichun City from January 2020 to June 2022 were retrospectively analyzed,the risk factors related to AVF failure were analyzed.Result:AVF failure occurred in 28(31.46%)of 89 patients with chronic renal failure underwent AVF.Univariate analysis showed that the proportions of age≥60 years old,hypotension,smoking history,calcium-phosphorus product≥55 mg^(2)/dL^(2),diabetic nephropathy,hyperlipidemia,serum albumin level<35 g/L in AVF failure group were significantly different from those in non-AVF failure group(P<0.05);there were no significant differences in gender,body mass index and internal fistula use time between the two groups(P>0.05).Multivariate analysis showed that age≥60 years[β=1.427,OR=4.167,95%CI(1.287,13.493)],hypotension[β=1.266,OR=3.548,95%CI(1.263,9.968)],smoking history[β=2.647,OR=14.107,95%CI(4.561,43.631)],calcium-phosphorus product≥55 mg^(2)/dL^(2)[β=1.159,OR=3.185,95%CI(1.258,8.064)],diabetic nephropathy[β=2.478,OR=11.922,95%CI(3.996,35.574)],hyperlipidemia[β=1.657,OR=5.245,95%CI(1.951,14.097)],serum albumin level<35 g/L[β=1.499,OR=4.476,95%CI(1.719,11.658)]were high risk factors for AVF failure(P<0.05).Conclusion:AVF failure is related to age,hypotension,smoking history,calcium-phosphorus product,diabetic nephropathy,hyperlipidemia and serum albumin level.