摘要
目的探讨老年维持性血液透析患者自体动静脉内瘘(AVF)1年失功率的影响因素。方法选取2018年7月至2020年5月在广东省人民医院采用前臂AVF做为血管通路的118例维持性透析患者,分为老年组(≥60周岁)和非老年组(<60周岁),运用彩色多普勒超声检查并随访患者AVF失功情况。采用COX比例风险模型进行多因素分析老年患者AVF 1年失功率的影响因素。结果单因素分析提示AVF 1年失功率与内瘘穿刺部位血流量有关。Kaplan-Meier生存曲线及log-rank检验提示老年组患者AVF 1年通畅率显著低于非老年组,HR(95%CI)=3.612(1.085~12.020),P=0.036。两组分析提示:吻合口直径小于0.35 cm、内瘘穿刺部位血流量小于500 mL/min和桡动脉血流量小于400 mL/min患者AVF 1年通畅率显著降低(P<0.05)。COX比例风险模型多因素分析显示内瘘穿刺部位血流量是AVF 1年通畅率的独立影响因素。结论老年维持性血液透析患者AVF 1年失功率较高,需要密切关注并定期监测其穿刺部位血流量变化。
Objective To investigate the influence factors on one-year power loss of autologous arteriovenous fistula(AVF)in elderly patients with maintenance hemodialysis.Methods A total of 118 patients with maintenance dialysis who received autologous AVF of the forearm as vascular access in this hospital were selected from July 2018 to May 2020 and divided into the elderly group(≥60 years old)and the non-elderly group(<60 years old).Color doppler ultrasound was used to examine,and patients were followed up to assess AVF loss.COX proportional hazard model was used to analyze the influencing factors of one-year AVF power loss in elderly patients.Results Univariate analysis suggested that the one-year power loss of autologous AVF was related to blood flow at the puncture site and serum albumin.Kaplan-Meier survivorship curve and log-rank test indicated that the one-year patency rate of autologous AVF in the elderly group was significantly lower than that in the non-elderly group[hazard rate(HR)95%confidence interval(CI)=3.612(1.085-12.020),P=0.036].Subgroup analysis suggested that when the anastomotic diameter was less than 0.35 cm,puncture site blood flow less than 500 mL/min and radial artery blood flow less than 400 mL/min,the one-year patency rate of autologous AVF in patients was significantly reduced(P<0.05).Multivariate analysis of the Cox proportional hazards model showed that the blood flow at the puncture site was an"independent influencing factor"for the one-year patency rate of AVF.Conclusion Autologous AVF in elderly patients with maintenance hemodialysis has a higher power loss in one year,which requires close attention,and regularly monitoring the changes of blood flow at the puncture site.
作者
周清华
赵立艳
宋利
符霞
全梓林
崔冬梅
陈诚
冯仲林
梁华般
陶一鸣
叶智明
梁馨苓
ZHOU Qinghua;ZHAO Liyan;SONG Li;FU Xia;QUAN Zilin;CUI Dongmei;CHEN Cheng;FENG Zhonglin;LIANG Huaban;TAO Yiming;YE Zhiming;LIANG Xinling(Department of Nephrology,Blood Purification Center,Guangdong Provincial People′s Hospital/Guangdong Academy of Medical Sciences,Guangzhou,Guangdong 510030,China;School of Nursing,Southern Medical University,Guangzhou,Guangdong 510080,China;Medical College of Shantou University,Shantou,Guangdong 515000,China)
出处
《重庆医学》
CAS
2022年第3期409-413,共5页
Chongqing medicine
基金
广东省医学科学技术研究基金项目(A2021260)
广州市基础与应用基础研究项目(202102080292)
广州市科技计划项目产学研协同创新重大专项(201508020114)。
关键词
动静脉内瘘
老年人
血液透析
内瘘失功率
超声检查
arteriovenous fistula
the elderly
hemodialysis
internal fistula power loss
ultrasound examination
