中国血液净化

中国血液净化 ›› 2024, Vol. 23 ›› Issue (01): 53-56, 61.doi: 10.3969/j.issn.1671-4091.2024.01.012

• 血管通路 • 上一篇    下一篇

维持性血液透析患者内瘘侧上肢功能障碍及影响因素的研究

王欣欣   孙 超   黎 爽  郑涵絮   顾国燕   宋晓朵   于海艳   尹咏梅   吴海虹   田 欣   管月红   尚云霄   赵  爽    黄富表   马迎春   

  1. 100068 北京，首都医科大学康复医学院 中国康复研究中心北京博爱医院 1肾内科 7作业治疗科
    100074 北京，2中国航天科工集团七三一医院肾内科
    100071 北京，3北京丰台医院血液透析室
    100079 北京，4北京市铁营医院血液透析室
    100076 北京，5北京市丰台区南苑医院血液透析室
    100069 北京，6北京市丰台右安门医院血液透析室
  • 收稿日期:2023-07-04 修回日期:2023-09-21 出版日期:2024-01-12 发布日期:2024-01-12
  • 通讯作者: 马迎春 E-mail:mych323@163.com
  • 基金资助:
    丰台区卫生健康系统科研项目

The dysfunction of upper limb at the arteriovenous fistula or graft side and its influencing factors in maintenance hemodialysis patients

WANG Xin-xin, SUN Chao, LI Shuang, ZHENG Han-xu, GU Guo-yan, SONG Xiao-du, YU Hai-yan, YIN Yong-mei, WU Hai-hong, TIAN Xin, GUAN Yue-hong, SHANG Yun-xiao, ZHAO Shuang, HUANG Fu-biao, MA Ying-chun   

  1. Department of Nephrology, and 7Department of Occupational therapy, China Rehabilitation Research Center Beijing BoAi Hospital, Capital Medical University Rehabilitation Medical College, Beijing 100068, China; 2Department of Nephrology, China Aerospace Science and Industry Corporation 731 Hospital, Beijing 100074, China; 3Hemodialysis Center, Beijing Fengtai Hospital, Beijing 100071, China; 4Hemodialysis Center, Fengtai Rehabilitation Hospital of Beijing Municipality (Tieying Hospital), Beijing 100079, China; 5Hemodialysis Center, Fengtai Nanyuan Hospital, Beijing 100076, China; 6Hemodialysis Center, Beijing Fengtai You’anmen Hospital, Beijing 100069, China
  • Received:2023-07-04 Revised:2023-09-21 Online:2024-01-12 Published:2024-01-12
  • Contact: 100068 北京，首都医科大学康复医学院 中国康复研究中心北京博爱医院 1肾内科 E-mail:mych323@163.com
  • Supported by:
    丰台区卫生健康系统科研项目(2020-98)

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摘要： 目的  评估维持性血液透析(maintenance hemodialysis,MHD)动静脉内瘘右利手患者的双侧上肢功能，了解动静脉内瘘对上肢功能的影响及内瘘侧上肢功能的影响因素。 方法 横断面研究，纳入北京市6家血液透析中心的MHD动静脉内瘘且右利手患者，收集人口学资料、生化资料、握力、关节活动度及简易上肢功能检查(simple test for evaluating hand function,STEF)等上肢功能指标。内瘘侧及非内瘘侧上肢功能的比较采用t检验(或非参数检验)，采用多元线性回归分析MHD患者动静脉内瘘侧握力的影响因素。 结果 共入组MHD患者90例，其中男性51例(56.7%)，年龄(59.63±10.60)岁，中位透析龄62.50(24.00,113.00)月。患者非内瘘侧握力高于内瘘侧握力(t=-5.133，P＜0.001)；多元线性回归结果显示MHD患者内瘘侧握力与血肌酐(β=0.353，P＜0.001)、认知功能评分(β=0.223，P=0.006)呈正相关，与尿素清除指数(Kt/V)呈负相关(β=-0.235，P=0.007)，男性握力大于女性(β=-0.253，P=0.004)。非内瘘侧腕关节尺偏的角度大于内瘘侧(t=-2.814，P=0.006)。在STEF各项操作中，内瘘侧在大球(t=2.327，P=0.021)、大圆片(t=2.472，P=0.015)、布(t=2.688，P=0.008)项目中操作时间长于无内瘘侧。 结论 MHD患者内瘘侧握力、关节活动度及灵活性均存在下降，影响内瘘侧握力的因素包括性别、血肌酐、Kt/V和认知功能评分。

关键词: 维持性血液透析, 上肢功能, 动静脉内瘘

Abstract: Objective To evaluate the function of both upper limbs in right-handed maintenance hemodialysis (MHD) patients with arteriovenous fistula or graft for blood access, and to understand the influence of arteriovenous fistula or graft on upper limb function and the factors influencing the limb function at arteriovenous fistula or graft side.  Method  This was a cross-sectional study. Right-handed patients with arteriovenous fistula or graft from six hemodialysis centers in Beijing were enrolled. Demographic, biochemical data and upper limb function indexes including grip strength, range of joint motion, and Simple Test for Evaluating Hand Function (STEF) were collected. t test or non-parametric test was used to compare the upper limb function of arteriovenous fistula or graft side and non-fistula or graft side. Multivariate linear regression was used to analyze the influencing factors for grip strength at the arteriovenous fistula or graft limb side in MHD patients.  Results  A total of 90 MHD patients were enrolled, 51(56.7%) of the patients were males, the mean age was 59.63±10.60 years, and the median dialysis vintage was 62.50(24.00, 113.00) months. The grip strength of non-fistula or graft side was higher than that of fistula or graft side (23.03±10.77 vs. 20.66±10.52, t=-5.133, P＜0.001). Multivariate linear regression demonstrated that the grip strength at fistula or graft side was positively correlated to serum creatinine (β=0.353, P＜0.001) and cognitive function (β=0.223, P=0.006), and was negatively correlated to urea clearance index (Kt/V) (β=-0.235, P=0.007). The grip strength at fistula or graft side was higher in males than in females (β=-0.253, P=0.004). The motion range of carpal joint turned to ulnar side was greater in the non-fistula or graft limb than that in the fistula or graft limb (32.85±10.81 vs. 29.92±9.46, t=-2.814, P=0.006). In the STEF tests, the operation time for large ball (8.17±1.78 vs. 7.99±1.78，t=2.327，P=0.021), large disc (7.29±1.91 vs. 7.02±1.84，t=2.472，P=0.015) and cloth  (7.36±2.06 vs. 7.13±1.84，t=2.688，P=0.008) were longer in the fistula or graft side than those in the non-fistula or graft side, with the differences reached statistical significances (P＜0.05).  Conclusions  The grip strength, range of joint motion and flexibility were decreased in the fistula or graft side. The factors affecting the grip strength in fistula or graft side included gender, serum creatinine, Kt/V and cognitive function.

Key words: Maintenance hemodialysis, Upper limb function, Arteriovenous fistula or graft

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