CAJ | 학술논문

目的探讨影响自体动静脉内瘘早期功能失败(失功)的相关因素,并进一步分析其主要影响因素,为临床早期干预提供参考依据.方法选择2008年1月～2009年2月在我院首次接受自体动静脉内瘘术的慢性血液透析患者214例,其中男性132例,女性82例,平均年龄(48±14)岁.内瘘早期失功定义为①透析时血流量持续<200ml/min且超声检测吻合口静脉管径≤0.4cm;或②首次使用后3个月内透析血流量消失.对患者年龄、件别、原发病、手术资料以及患者在内瘘成熟前已临时置管透析和导管留置时间等10组预测指标进行量化后Logistic回归分析.结果 38例(17.8%)发生早期内瘘失功,患者低血压状态(RR4.2,P=0.009)、原发糖尿病(RR2.8,P=0.041)、体重指数低(RR1.1,P=0.000)、手术技术(RR0.86,P=0.036)是主要影响因素,值得注意的是:本研究发现忠者临时插管通路不影响内瘘早期功能状况(RR 2.6,95%C1 0.28～25.29,P=0.401),但留置导管的时间是影响因素(RR 1.1,95%CI 1.03～6.72,P=0.001).结论本研究进一步证实患者低血压状态、原发糖尿病、体重指数低、手术熟练程度和临时导管通路留置时间是影响内瘘早期功能状况的重要因素,强调内瘘手术应在患者计划维持性血液透析前提早实施,减少初始透析时临时导管通路和长时间使用,有利于提高内瘘的开通率,减少并发症的出现.
목적 탐토영향자체동정맥내루조기공능실패(실공)적상관인소,병진일보분석기주요영향인소,위림상조기간예제공삼고의거.방법 선택2008년1월～2009년2월재아원수차접수자체동정맥내루술적만성혈액투석환자214례,기중남성132례,녀성82례,평균년령(48±14)세.내루조기실공정의위①투석시혈류량지속<200ml/min차초성검측문합구정맥관경≤0.4cm;혹②수차사용후3개월내투석혈류량소실.대환자년령、건별、원발병、수술자료이급환자재내루성숙전이림시치관투석화도관류치시간등10조예측지표진행양화후Logistic회귀분석.결과 38례(17.8%)발생조기내루실공,환자저혈압상태(RR4.2,P=0.009)、원발당뇨병(RR2.8,P=0.041)、체중지수저(RR1.1,P=0.000)、수술기술(RR0.86,P=0.036)시주요영향인소,치득주의적시:본연구발현충자림시삽관통로불영향내루조기공능상황(RR 2.6,95%C1 0.28～25.29,P=0.401),단류치도관적시간시영향인소(RR 1.1,95%CI 1.03～6.72,P=0.001).결론 본연구진일보증실환자저혈압상태、원발당뇨병、체중지수저、수술숙련정도화림시도관통로류치시간시영향내루조기공능상황적중요인소,강조내루수술응재환자계화유지성혈액투석전제조실시,감소초시투석시림시도관통로화장시간사용,유리우제고내루적개통솔,감소병발증적출현.
Objectives This study was aimed to identify early failure of the first native arteriovenous fistula (AVF) in patients on maintenance hemodialysis (HD) and the factors responsible for the failure, for the planning on early intervention strategies. Methods A retrospective study was conducted in 214 patients (aged 48± 14years, 132 males), who received the first native AVF operation for maintenance HD in West China Hospital from Jan, 2008 to Feb, 2009. Early failure was defined as (a) a blood flow volume < 200ml/min inadequate to support dialysis therapy with a venous diameter of ≤0.4cm detected by ultrasound, and (b) the AVF failure occurring within the first 3 months of its use. Factors potentially relating to the failure of the first AVF including age, gender, primary disease, surgical procedure, and dwelling duration of central vein catheter-ization (CVC) before use of the AVF were collected and studied using binary Logistic regression analysis. Results Early failure of the AVF was found in 38 (17.8%) patients, of whom the major risk factors included hypotension status (RR=4.2, P=0.009), diabetes (RR=2.8, P=0.041), low body mass index (BMI) (RR=1. 1,P=0.000), and surgical techniques (RR=0.86, P=0.036). Although CVC before the use of AVF showed no correlation with the early failure ofAVF (RR=2.6, 95% C1=0.28-25.29, P=0.401), the dwelling duration of CVC was a risk factor (RR=1.1, 95% CI=1.03-6.72, P=0.001 ). Conclusion Early failure of the first native AVF correlates with hypotension, diabetes, BMI of the patient, surgical techniques, and dwelling duration of CVC. Native AVF should be established before the commencement of maintenance HD, so that the possibility of CVC and its dwelling duration can be reduced, and the patency of AVF can be improved with the decrease of its complications.