血液透析患者自体动静脉内瘘狭窄发生高危因素分析

冯文菊 徐海燕 陈璐

[關键词] 血液透析;自体动静脉内瘘;狭窄;高危因素

[中图分类号] R692.5          [文献标识码] B          [文章编号] 1673-9701（2021）29-0049-04

Analysis of high-risk factors for autologous arteriovenous fistula stenosis in hemodialysis patients

FENG Wenju1   XU Haiyan2   CHEN Lu3

1.Blood Purification Center，Taizhou Hospital in Zhejiang Province affiliated to Wenzhou Medical University，Taizhou   317000， China; 2.Department of Emergency，Taizhou Hospital in Zhejiang Province affiliated to Wenzhou Medical University，Taizhou   317000， China; 3.Department of Nephrology， Taizhou Hospital in Zhejiang Province  affiliated to Wenzhou Medical University， Taizhou   317000， China

[Abstract] Objective To investigate the high-risk factors of autologous arteriovenous fistula stenosis in hemodialysis patients. Methods The clinical data of 128 patients diagnosed with uremia who underwent hemodialysis in our hospital from January to December 2019 were selected for retrospective analysis. According to whether the patients had arteriovenous fistula stenosis，they were divided into the stenosis group （n=36） and the non-stenosis group （n=92）. The patients' general data， clinical data were calculated. The single-factor and multi-factor analyses were used to analyze high-risk factors for autologous arteriovenous fistula stenosis in hemodialysis patients. Results （1） The incidence of arteriovenous anastomotic leakage stenosis of patients with age≥66 years，diabetic nephropathy，surgical site in the forearm，end-to-end anastomosis， C-reactive protein>8 mg/L， blood calcium<2.25 mmol/L， total cholesterol>6.45 mmol/L，triglyceride≥2.26 mmol/L was higher in patients，and the incidence in patients with oral anticoagulants was lower， and the difference was statistically significant （P<0.05）. （2） The results of the multi-factor analysis showed age ≥66 years，diabetic nephropathy，surgical site in the forearm，end-to-end anastomosis，C-reactive protein>8 mg/L， blood calcium<2.25 mmol/L， total cholesterol>6.45 mmol/L，triglycerides≥2.26 mmol/L were an independent risk factor for autologous arteriovenous fistula stenosis in hemodialysis patients， while oral anticoagulants were a protective factor（all P<0.05）. Conclusion The elderly patients are prone to autogenous arteriovenous fistula stenosis， which should be paid attention to in clinical practice and attention should be paid to prevention. Patients with diabetic nephropathy should strictly control blood sugar， and patients with hyperlipidemia should pay attention to lipid-lowering treatment. Forearm vessels and end-to-end anastomosis are prone to stenosis. Therefore， clinically as long as conditions permit， upper arm vessels should be selected as far as possible， and side-to-side anastomosis should be selected. In addition， attention should be paid to whether patients have long-term chronic inflammation. For patients with hypocalcemia， calcium should be supplemented in time. Oral anticoagulants can prevent autogenous arteriovenous fistulas. Clinically， for patients with no contraindications and indications， oral anticoagulants can be selected for prevention.

[Key words] Hemodialysis; Autogenous arteriovenous fistula; Stenosis; High risk factors

自体动静脉内瘘是终末期肾脏病患者血液透析治疗血管通路的一种，是将患者体内血液持续引至体外并再返回体内的途径。自体动静脉内瘘相较于其他类型通路，具有血栓形成率低、狭窄率低、可反复穿刺、感染率低等优势，使用寿命相对较长。但仍然有部分患者出现狭窄，影响使用寿命。目前动静脉内瘘狭窄的具体机制尚不十分清楚，一般认为血管内膜增生是狭窄的病理基础，糖尿病、高血压、血脂异常、高钙磷乘积、贫血等可能是动静脉内瘘狭窄的高危因素，其他手术相关影响因素可能也会影响狭窄的发生[1]。本研究通过回顾性分析，探讨影响血液透析患者自体动静脉内瘘狭窄的相关因素，以期为临床提供参考，现报道如下。

1 资料与方法

1.1一般资料

回顾性分析2019年1—12月在我院诊断为尿毒症并行血液透析患者128例的临床资料。纳入标准[2]：①年龄≥18周岁;②所有患者均采用动静脉内瘘作为血管通路;③在动静脉内瘘成熟后开始使用时，可提供≥200 mL/min血流量;④临床资料完整。排除标准[2]：①恶性肿瘤;②其他脏器功能不全;③休克、创伤等导致动静脉内瘘失功;④免疫系统疾病;⑤认知功能障碍、听力障碍等其他不能配合治疗的情况。根据患者是否发生动静脉内瘘狭窄分为狭窄组36例与无狭窄组92例。

1.2 方法

统计两组患者性别、年龄、原发疾病史、手术部位（上臂、前……