长透析龄血液透析患者自体动静脉内瘘失功的危险因素分析

孔若曦; 葛益飞; 许雪强; 杨家慧; 毛慧娟; 邢昌赢

doi:10.3969/j.issn.1671-2390.2023.11.002

长透析龄血液透析患者自体动静脉内瘘失功的危险因素分析

Risk factors of autologous arteriovenous fistula nonfunction in long-term hemodialysis patients

摘要

摘要:
目的探究影响透析龄超10年的维持性血液透析患者自体动静脉内瘘失功的因素。
方法选取2022年3月至2022年9月在南京医科大学第一附属医院和南京市栖霞区医院两个血液透析中心接受维持性血液透析患者中透析龄超10年的患者50例。按是否发生过内瘘失功分为事件组（n = 26）和非事件组（n = 24），分析比较纳入患者一般资料和实验室检查资料，探寻各项指标对自体动静脉内瘘失功的影响。
结果两组患者资料比较分析，事件组的内瘘初次穿刺时间显著早于非事件组，胆固醇（4.26 ± 1.25）mmol/L比（3.53 ± 0.97）mmol/L、视黄醇结合蛋白（122.69 ± 31.31）μg/mL比（99.33 ± 14.21）μg/mL显著高于非事件组，而两组的不同穿刺方式占比和血流量分布也存在差异，具有统计学意义（P＜0.05）。Cox比例风险模型多因素分析提示高龄、上臂内瘘、区域穿刺法、初次穿刺时间是影响内瘘失功的危险因素。
结论前臂内瘘和适当延缓内瘘初次穿刺时间在延长自体动静脉内瘘使用寿命方面具有优势，而高龄、区域穿刺法可增加自体动静脉内瘘失功的风险。

Abstract:
Objective To explore the influencing factors for the risk of autologous arteriovenous fistula (AVF) nonfunction in patients on hemodialysis (HD) for >10 years.
Methods A total of 50 patients on HD >10 years were assigned into two groups of nonfunction (n=26) and function (n=24) according to the presence or absence of AVF nonfunction. General profiles and laboratory parameters were compared between two groups for evaluating the effects of various indicators on AVF nonfunction.
Results Initial cannulation time for AVF was significantly earlier in nonfunction group than that in function group. The levels of cholesterol and retinol-binding protein were significantly higher than those in function group. Inter-group differences also existed in the proportions of different cannulation techniques and blood flow distribution (P<0.05). Multivariate Cox regression analysis indicated that advanced age at an initial hemodialysis, upper arm AVF, area puncture cannulation technique and initial cannulation time were the significant influencing factors for AVF nonfunction.
Conclusions Patients with forearm AVF and a longer initial cannulation time are more prone to AVF while advanced age and area puncture cannulation technique may elevate the risks of AVF nonfunction.

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