成年维持性血液透析患者动静脉内瘘上肢功能与健康个体比较的研究

The comparison of upper limb function between maintenance hemodialysis patients with arteriovenous fistula or arteriovenous graft and healthy adults

目的比较维持性血液透析(maintenance hemodialysis,MHD)动静脉内瘘右利手患者与成年健康个体之间上肢功能的差异。方法横断面研究,纳入北京市6家血液透析中心的MHD动静脉内瘘且右利手患者,收集人口学资料、生化资料、握力及简易上肢功能检查(simple test for evaluating hand function,STEF)等上肢功能指标。MHD患者及成年健康个体上肢功能的比较采用t检验。结果共入组MHD患者90例,其中男性51例(56.7%),年龄(59.63±10.60)岁,中位透析龄62.50(24.00,113.00)个月。将入组的MHD患者按照性别及年龄分组,与成年同年龄段健康人群的握力相比,35~40岁组[女性:(20.27±1.10)kg比28 kg,t=-9.968,P=0.064;男性:(25.85±8.38)kg比45 kg,t=-4.998,P=0.038]、41~50岁组[女性:(20.37±9.25)kg比28 kg,t=-1.844,P=0.139;男性:(27.59±10.43)kg比43 kg,t=-4.433,P=0.002]、51~60岁组[女性:(17.99±8.84)kg比26 kg,t=-2.717,P=0.026;男性:(25.64±9.04)kg比40 kg,t=-4.205,P=0.006]及61~70岁组[女性:(14.11±9.45)kg比23 kg,t=-3.880,P=0.001;男性:(27.41±9.22)kg比36 kg,t=-4.837,P<0.001]握力均存在下降。STEF各项目操作时间均高于中国健康人群。结论动静脉内瘘患者的握力及灵活性与健康人群相比均存在下降。

Objective To compare the upper limb function between right-handed maintenance hemodialysis(MHD)patients with arteriovenous fistula(AVF)or AVF graft and healthy adults.Method The righthanded MHD patients with AVF or AVF graft for blood access from six hemodialysis centers in Beijing were enrolled in this cross-sectional study.Demographic and biochemical data,grip strength,and the operation time of Simple Test for Evaluating Hand Function(STEF)were collected.t-test was used to compare the upper limb function between MHD patients and healthy adults.Results A total of 90 MHD patients were enrolled,51 patients were males,the mean age was 59.63±10.60 years,and the median dialysis vintage was 62.50(24.00,113.00)months.The MHD patients were divided into 8 groups by gender and age.The grip strength of MHD patients vs.healthy adults in the age groups were 35-40 years old(female:20.27±1.10 vs.28kg,t=-9.968,P=0.064;male:25.85±8.38 vs.45kg,t=-4.998,P=0.038),41-50 years old(female:20.37±9.25 vs.28kg,t=-1.844,P=0.139;male:27.59±10.43 vs.43kg,t=-4.433,P=0.002),51~60 years old(female:17.99±8.84 vs.26kg,t=-2.717,P=0.026;male:25.64±9.04 vs.40kg,t=-4.205,P=0.006),and 61~70 years old(female:14.11±9.45 vs.23kg,t=-3.880,P=0.001;male:27.41±9.22 vs.36kg,t=-4.837,P<0.001),indicating grip strength decreased in MHD patients as compared with healthy adults of the same age range.The operation time of each STEF items increased in MHD patients than in Chinese healthy adults(P<0.05).Conclusions The grip strength and flexibility were lower in MHD patients with AVF or AVF graft than in healthy people.