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冯文菊1 徐海燕2 陈 璐3.血液透析患者自体动静脉内瘘狭窄发生高危因素分析[J].中国现代医生,2021,59(29):49-52
血液透析患者自体动静脉内瘘狭窄发生高危因素分析
Analysis of high-risk factors for autologous arteriovenous fistula stenosis in hemodialysis patients
  
DOI:
中文关键词:  血液透析  自体动静脉内瘘  狭窄  高危因素
英文关键词:Hemodialysis  Autogenous arteriovenous fistula  Stenosis  High risk factors
基金项目:浙江省医药卫生科技计划项目(2018KY882)
作者单位
冯文菊1 徐海燕2 陈 璐3 1.浙江省台州医院血液净化中心浙江台州 3170002.浙江省台州医院急诊科浙江台州 3170003.浙江省台州医院肾内科浙江台州 317000 
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中文摘要:
      目的 探讨血液透析患者自体动静脉内瘘狭窄发生的高危因素。方法 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,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。统计两组患者一般资料、临床资料,单因素及多因素分析血液透析患者自体动静脉内瘘狭窄发生的高危因素。结果 (1)年龄≥66 岁、糖尿病肾病、手术部位在前臂、端-端吻合、C 反应蛋白>8 mg/L、血钙<2.25 mmol/L、总胆固醇>6.45 mmol/L、三酰甘油≥2.26 mmol/L 的患者动静脉吻合口瘘狭窄的发生率更高,口服抗凝药的患者发生率更低,差异有统计学意义(P<0.05)。(2)多因素分析结果显示,年龄≥66 岁、糖尿病肾病、手术部位在前臂、端-端吻合、C 反应蛋白>8 mg/L、血钙<2.25 mmol/L、总胆固醇>6.45 mmol/L、三酰甘油≥2.26 mmol/L是血液透析患者自体动静脉内瘘狭窄发生的独立危险因素,而口服抗凝剂是保护因素(P 均<0.05)。结论 高龄患者容易发生自体动静脉内瘘狭窄,临床上应引起重视,注意预防。糖尿病肾病患者应严格控制血糖,高脂血症患者应注意调脂治疗。前臂血管、端-端吻合容易发生狭窄,因此临床上只要条件允许,应尽量选择上臂血管,并选择侧-侧吻合。另外,应注意患者是否有长期慢性炎症反应,对于合并低钙血症的患者应注意及时补钙。口服抗凝剂可预防自体动静脉内瘘,临床上对于无禁忌证、有适应证的患者,可选择口服抗凝剂预防。
英文摘要:
      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-toend 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.
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