中国血液净化

中国血液净化 ›› 2023, Vol. 22 ›› Issue (09): 710-714.doi: 10.3969/j.issn.1671-4091.2023.09.017

• 血管通路 • 上一篇    下一篇

血液透析行扣眼穿刺患者动静脉内瘘发生内膜增生的影响因素分析

赵秀明   牛洪艳    刘金凤    孙 琳    黄 丽   宋月霞   

  1. 213003 常州，常州市第一人民医院1血液净化中心 2肾内科
  • 收稿日期:2023-04-14 修回日期:2023-06-15 出版日期:2023-09-12 发布日期:2023-09-12
  • 通讯作者: 牛洪艳 E-mail:ahniuhongyan2010@163.com
  • 基金资助:
    常州市第一人民医院2020年科技项目(yy2020002)

The influencing factors for the intimal hyperplasia in arteriovenous fistula in patients with buttonhole puncture for hemodialysis

ZHAO Xiu-ming, NIU Hong-yan, LIU Jin-feng, SUN Lin, HUANG Li, SONG Yue-xia   

  1. Blood Purification Center and 2Department of Nephrology, The First People’s Hospital of Changzhou, Jiangsu 213003, China
  • Received:2023-04-14 Revised:2023-06-15 Online:2023-09-12 Published:2023-09-12
  • Contact: 213003 常州，常州市第一人民医院1血液净化中心 E-mail:ahniuhongyan2010@163.com

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摘要： 目的  探讨扣眼穿刺患者动静脉内瘘发生内膜增生的影响因素，为进一步采取针对性的干预提供科学依据。 方法  采用方便抽样法选取2021年1月—12月在常州市第一人民医院的血液透析患者，对其中扣眼穿刺患者进行调查。以内膜增生组和正常组为二分类因变量，患者一般资料及扣眼穿刺相关指标为自变量，运用单因素分析、非条件Logistic回归分析方法，分析内膜增生的影响因素；绘制受试者工作特征(ROC)曲线以预测血管内膜增生风险筛查的最佳临界值。 结果  85例扣眼穿刺患者中内膜增生发生率为68.2%，二元Logistic回归分析结果显示：扣眼使用时间(OR=1.059,95% CI：1.004～1.116,P=0.036)、正常静脉内径(OR=0.744,95% CI：0.589～0.940,P=0.013)、有无感染发生(OR=7.460,95% CI：1.685～33.033,P=0.008)是内瘘血管内膜增生的影响因素；ROC曲线预测血管内膜增生的最佳临界时间是扣眼使用时间到达10.5个月时。 结论  扣眼穿刺处血管内膜增生发生率较高，与扣眼使用时间过长、正常静脉内径纤细、感染发生密切相关。为防止血管内膜增生引起的血管通路并发症，建议临床护理人员应严格掌握扣眼穿刺技术的适用范围，提升对扣眼穿刺患者内膜增生的认识，及早采取干预措施，并且实施更加严格的监测机制。

关键词: 血液透析, 动静脉内瘘, 扣眼穿刺, 内膜增生, 影响因素分析

Abstract: Objective  To investigate the influencing factors for the intimal hyperplasia in arteriovenous fistula (AVF) in patients with buttonhole puncture for hemodialysis, so as to provide scientific basis for the intervention.  Methods  The patients using buttonhole puncture for hemodialysis in The First People’s Hospital of Changzhou during January 2021 to December 2021 were selected by the convenience sampling method. They were divided into intimal hyperplasia group and normal group as the binary dependent variables, and the general clinical information and relevant indexes of buttonhole puncture were used as the independent variables. Univariate analysis and unconditional logistic regression analysis were used to analyze the influencing factors for intimal hyperplasia. Receiver operating characteristic (ROC) curve was plotted to obtain the optimal critical value for predicting intimal hyperplasia.  Results  The incidence of intimal hyperplasia in the 85 patients using buttonhole puncture was 68.2%. Binary logistic regression showed that use time of the buttonhole (OR=1.059, 95% CI 1.004～1.116, P=0.036), normal vein diameter (OR=0.744, 95% CI 0.589～0.940, P=0.013) and infection (OR=7.460, 95% CI 1.685～33.033, P=0.008) were the influencing factors for intimal hyperplasia in AVF. ROC curve predicted that the optimal critical time for intimal hyperplasia was the use of the buttonhole for 10.5 months.  Conclusion The incidence of intimal hyperplasia in AVF is high at the puncture site of buttonhole, which is closely related to long-term use of the buttonhole, slender diameter of normal vein and infection. Clinical nurses should understand the indications of buttonhole puncture and the relationship between intimal hyperplasia and buttonhole puncture, take early intervention measures, and implement strict monitoring measures to prevent access complications caused by intimal hyperplasia in AVF.

Key words: Hemodialysis, Arteriovenous fistula, Buttonhole puncture, Intimal hyperplasia, Root cause analysis

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