中国血液净化

中国血液净化 ›› 2025, Vol. 24 ›› Issue (09): 776-780.doi: 10.3969/j.issn.1671-4091.2025.09.011

• 血管通路 • 上一篇    下一篇

维持性血液透析患者自体动静脉内瘘晚期血栓形成的影响因素分析#br#

张 艳    姜惠丽    刘 芳    许永仓    杜红霞   

  1. 250013 济南，山东第一医科大学附属中心医院1肾脏病/血液净化科 2护理部
  • 收稿日期:2025-02-04 修回日期:2025-07-08 出版日期:2025-09-12 发布日期:2025-09-12
  • 通讯作者: 杜红霞 E-mail:zxyydhx@126.com
  • 基金资助:
    济南市卫生健康委员会科技计划项目(2024205005)

Factors influencing the presence of late thrombosis in autogenous arteriovenous fistulas in patients on maintenance haemodialysis

ZHANG Yan, JIANG Hui-li, LIU Fang, XU Yong-cang, DU Hong-xia   

  1. 1Nephrology/Blood Purification, and 2Department of Nursing, The Central Hospital Affiliated to Shandong First Medical University, Jinan 250013, China
  • Received:2025-02-04 Revised:2025-07-08 Online:2025-09-12 Published:2025-09-12
  • Contact: 250013 济南，山东第一医科大学附属中心医院2护理部 E-mail:zxyydhx@126.com

摘要： 目的 分析维持性血液透析(maintenance hemodialysis，MHD)患者自体动静脉内瘘晚期血栓形成的影响因素。 方法 横断面调查研究，收集2023年1月—12月就诊于山东第一医科大学附属中心医院血管通路门诊的MHD患者的临床资料，按是否发生自体动静脉内瘘血栓(arteriovenous fistula thrombosis，AVFT)分为通畅组和阻塞组，使用二元Logistic回归法分析影响因素。 结果 共纳入521例患者，内瘘血栓形成252例(48.37%)。二元Logistic回归分析显示：压迫止血时间(OR=8.145，95% CI：3.543～18.727，P＜0.001)、近一个月内瘘功能(包括有无透析中流量不足、静脉压高、穿刺失败)(OR=47.404，95% CI：11.127～201.949，P＜0.001)、透析前收缩压(OR=0.971，95% CI：0.949～0.993，P=0.011)、透析前舒张压(OR=1.111，95% CI：1.076～1.148，P＜0.001)、透析中最低舒张压(OR=0.923，95% CI：0.886～0.961，P＜0.001)、区域穿刺(OR=66.674，95% CI：7.505～592.350，P＜0.001)、扣眼穿刺(OR=18.578，95% CI：6.154～56.086，P＜0.001)、既往2次及以上内瘘失功病史(OR=3.967，95% CI：1.614～9.751，P=0.003)是MHD患者发生AVFT的影响因素。 结论 压迫止血时间≥30 min、近一个月内瘘功能异常、高透析前舒张压、既往多次内瘘失功史是AVFT形成的危险因素；绳梯穿刺、高透析前收缩压、高透析中最低舒张压是预防AVFT形成的保护因素。

关键词: 肾透析, 自体动静脉内瘘, 血栓, 影响因素

Abstract:

 Objective  This study aimed to analyze and explore the factors influencing the presence of late thrombosis in autogenous arteriovenous fistula (AVF) in patients on maintenance hemodialysis (MHD).  Methods  In this cross-sectional study, Clinical data of the patients who received MHD at the Hemodialysis Vascular Access Clinic, The Central Hospital Affiliated to Shandong First Medical University between January 2023 and December 2023 were collected. Patients were divided into a patency group and an obstruction group based on the presence or absence of thrombosis in AVF. Binary logistic regression was used to explore the potential influencing factors.  Results  A total of 521 MHD patients were included in this study, among whom thrombosis in AVF occurred in 252 cases (48.37%). Binary logistic regression analysis showed that compression time for hemostasis (OR=8.145, 95% CI: 3.543～18.727, P＜0.001), fistula functions (including insufficient blood flow during hemodialysis, high venous pressure, and puncture failure) in the latest month (OR=47.404, 95% CI: 11.127～201.949, P＜0.001), pre-dialysis systolic blood pressure (OR=0.971, 95% CI: 0.949～0.993, P=0.011), pre-dialysis diastolic blood pressure (OR=1.111, 95% CI:1.076～1.148, P＜0.001), minimum diastolic blood pressure during hemodialysis (OR= 0.923, 95% CI: 0.886～0.961, P＜0.001), regional cannulation (OR=66.674, 95% CI: 7.505～592.350, P＜0.001), buttonhole cannulation (OR=18.578, 95% CI: 6.154～56.086, P＜0.001), and a history of AVF dysfunction for two or more two times (OR=3.967, 95% CI: 1.614～9.751, P=0.003) were the risk factors influencing the presence of thrombosis in AVF.  Conclusion Compression time for hemostasis ≥30 minutes, AVF dysfunction in the latest month, higher pre-dialysis diastolic blood pressure, and a history of multiple AVF failures were the risk factors for late thrombosis in AVF, while rope ladder cannulation, high pre-dialysis systolic blood pressure, and high minimum diastolic blood pressure during hemodialysis were the protective factors against late thrombosis in AVF.
 
 

Key words: Kidney dialysis, Autogenous arteriovenous fistula, Thrombus, Influencing factor

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