维持性血液透析患者透析通路相关缺血综合征发病率及相关因素

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.

Incidence of dialysis access induced ischemic syndrome and its risk factors

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.