目的  肿胀手综合征(swollen hand syndrome,SHS)为维持性血液透析(maintenance hemodialysis，MHD)患者常见的血管通路并发症之一，探讨MHD患者动静脉内瘘(arteriovenous fistula，AVF)侧手臂SHS的危险因素，为SHS的早期识别及临床干预提供理论依据。 方法  本研究采用横断面研究，选取2025年7─8月广东省人民医院血液净化中心MHD患者，分为SHS组和非SHS组。收集一般资料、基础疾病、通路病史及不同部位臂围数据，通过单、多因素Logistic回归分析，筛选SHS发生的危险因素。 结果  共纳入422例使用AVF的MHD患者，SHS发生率15.6%(66/422)。SHS组和非SHS组在性别(F=14.120，P＜0.001)、AVF侧颈内静脉置管史(F=10.156，P=0.001)、有AVF建立史(F=5.376，P=0.020)和臂围在AVF侧腕部(F=11.972，P＜0.001)、前臂中段(F=16.553，P＜0.001)、上臂中段(F值=40.083，P＜0.001)部位有显著差异；将上述因素纳入多因素Logistic回归模型显示：AVF侧与非AVF侧上臂中段臂围差值(OR=3.526,95%CI：2.494～4.985,P＜0.001)、狭窄处可听诊到高调杂音(OR=4.675,95%CI：2.018～10.827，P＜0.001)、震颤减弱(OR=5.080,95% CI：1.372～18.807,P=0.015)、年龄(OR=0.967，95%CI：0.955～0.980，P＜0.001)及性别(OR=0.375，95% CI：0.197～0.716，P=0.003)为MHD患者AVF侧手臂并发SHS的危险因素。 结论  MHD患者使用AVF期间，需监测上臂中段臂围、定期听诊排查狭窄，女性、年轻患者需重点筛查高危因素。临床规范监测臂围差值并联合超声检查，尽早干预，减少SHS不良影响。

Objective  Swollen hand  syndrome is a common vascular access complication in maintenance hemodialysis (MHD) patients. This study aimed to explore the risk factors for hand swelling at arteriovenous fistula (AVF) side in MHD patients, so as to provide theoretical evidences for early identification and clinical intervention of hand swelling syndrome.  Methods  This was a cross-sectional study. A total of 422 MHD patients treated at the Blood Purification Center of Guangdong Provincial People’s Hospital from July to August 2025 were enrolled and divided into two groups based on the presence or absence of hand swelling. General information, underlying diseases, vascular access history and arm circumference measurements at multiple sites were collected. Univariate and multivariate logistic regression analyses were performed to identify the risk factors for hand swelling.  Results  Among the 422 MHD patients with functional AVFs, the incidence of hand swelling was 15.6% (66/422). Significant intergroup differences were observed in gender (F=14.120, P＜0.001), history of internal jugular vein catheterization on AVF side (F=10.156, P=0.001), history of previous AVF creation (F=5.376, P=0.020), and circumference differences at lateral wrist (F=11.972, P＜0.001), mid-forearm (F=16.553, P＜0.001) and mid-upper arm (F=40.083, P＜0.001) between hand swelling group and non-hand swelling group. Multivariate logistic regression demonstrated that mid-upper arm circumference difference between the two arms (OR=3.526, 95% CI：2.494～4.985, P＜0.001), high-pitched murmur at stenosis site (OR=4.675, 95% CI：2.018～10.827, P＜0.001), reduced AVF thrill (OR=5.080,  95% CI：1.372～18.807, P=0.015), age (OR=0.967, 95% CI：0.955～0.980, P＜0.001), and gender (OR=0.375, 95% CI：0.197～0.716, P=0.003) were the risk factors for the presence of hand swelling at AVF side.  Conclusions  Monitoring of mid-upper arm circumference and auscultation to detect stenosis in AVF should be regularly carried out to reveal the risk factors for hand swelling during the use of AVF for blood access, especially for female and younger MHD patients. Standardized surveillance of arm circumference differences combined with ultrasonography facilitate early intervention and adverse outcome prevention of hand swelling syndrome.