CAJ | 학술논문

目的调查维持性血液透析患者透析通路相关缺血综合征及窃血现象发病率,对缺血综合征发生的危险因素进行分析.方法采用横断面研究,选取2012年1至3月在北京市海淀医院以头静脉-桡动脉端侧吻合自体动静脉内瘘为通路行维持性血液透析者71例,询问并检查患者是否存在内瘘侧肢端发凉、发绀等缺血症状;应用彩色多普勒超声观察动静脉内瘘吻合口桡动脉近心端、远心端是否存在反向血流,测量内瘘吻合口、桡动脉、肱动脉内径及血流量;记录入组患者性别、高血压、糖尿病、吸烟和动脉硬化等,对上述指标进行量化后行logistic回归分析.结果透析通路相关缺血综合征发病率为19.7％(14/71).彩色多普勒超声显示,桡动脉远端血流方向及频谱方向均为反向者42例(59.2％).多元回归分析显示,内瘘口径大小、肱动脉血流量、女性、糖尿病、动脉硬化不是缺血综合征的危险因素(均P＞0.05).结论动静脉内瘘后,缺血综合征发生率不低,目前尚不能通过控制内瘘口径大小等方法预防其发生.
목적 조사유지성혈액투석환자투석통로상관결혈종합정급절혈현상발병솔,대결혈종합정발생적위험인소진행분석.방법 채용횡단면연구,선취2012년1지3월재북경시해정의원이두정맥-뇨동맥단측문합자체동정맥내루위통로행유지성혈액투석자71례,순문병검사환자시부존재내루측지단발량、발감등결혈증상;응용채색다보륵초성관찰동정맥내루문합구뇨동맥근심단、원심단시부존재반향혈류,측량내루문합구、뇨동맥、굉동맥내경급혈류량;기록입조환자성별、고혈압、당뇨병、흡연화동맥경화등,대상술지표진행양화후행logistic회귀분석.결과 투석통로상관결혈종합정발병솔위19.7％(14/71).채색다보륵초성현시,뇨동맥원단혈류방향급빈보방향균위반향자42례(59.2％).다원회귀분석현시,내루구경대소、굉동맥혈류량、녀성、당뇨병、동맥경화불시결혈종합정적위험인소(균P＞0.05).결론 동정맥내루후,결혈종합정발생솔불저,목전상불능통과공제내루구경대소등방법예방기발생.
Objective To investigate the incidence and risk factors of dialysis access induced ischemic syndrome (DAIIS).Methods A cross-sectional study was conducted in 71 maintenance hemodialysis (MHD) patients whose access were autogenous radial-cehalic end-to-side anastomosis fistula in Beijing Haidian Hospital from January to March 2011.The definition of ischemia was the development of cool,pale,numbness,pain,muscle atrophy,ulcers,necrosis distal to the fistula site.Ultrasound recorded the distal radial flow direction and frequency spectrum.The diameter and blood flow of the brachial artery and the radial artery,diameter of anastomosis and clinical data including gender,diabetes,hypertension,arteriosclerosis were collected and studied by using binary Logistic regression analysis.Results The incidence of DAIIS was 19.7％ (14/71) and steal phenomenon 59.2％ (42/71).Logistic regression indicated that diameter of anastomosis,blood flow of the brachial artery,gender,diabetes,hypertension,smoking,artheriosclerosis had no correlation with DAIIS.Conclusion DAIIS is common in MHD using AVF.Currently it is not available through control anastomotic diameter,and other methods to prevent its occurrence.