老年血透患者动静脉内瘘并发症监测及其影响因素分析

目的检测老年血透患者动静脉内瘘（AVF）并发症发生率并分析其血流动力学参数与影响因素。方法采用高频B超检测41例老年血透患者临床功能正常的AVF并发症情况及血流动力学参数，并记录临床及生化数据，按狭窄和血栓有无分为阳性组和阴性组。对两组各数据进行比较，并对并发症产生的各危险因素进行Logistic回归分析。结果AVF临床功能正常的老年血透患者隐匿性并发症发生率为39．02％。并发症阳性组患者与阴性组患者供血桡动脉内径（P=0．015）、血流量（P=0．015）、桡动脉舒张末期血流速度（P=0．038）间差别有统计学意义。而阻力指数（P=0．009）间差异有高度统计学意义。阳性组患者与阴性组患者收缩压差异有统计学意义（P=0．042），血浆前白蛋白、高密度脂蛋白和血磷水平差异均有高度统计学意义（P值均〈0．001）。Logistic多元回归分析结果提示高血磷水平（P=0．017）是AVF并发症发生的主要危险因素，而低前白蛋白（P=0．020）和低高密度脂蛋白水平（P=0．024）是保护因素。结论老年血透患者临床功能正常的AVF中存在较高比例的隐匿性并发症，供血桡动脉的血管病变是AVF并发症发生及通路失功的重要影响因素。高磷血症的纠正、营养不良和脂质紊乱的改善、良好的血压控制，对降低AVF并发症发生、延长通路存活期具有重要意义。

Arteriovenous fistula complications monitoring and its correlation factors analysis in elderly maintenance hemodialysis patients

Objective To monitor the latent complications of well-functioning arteriovenous fistula （AVF） and to evaluate its major risk factors as well as hemodynamics parameters analysis in elderly maintenance hemodialysis （e-MHD） patients. Methods Forty-one e-MHD patients with well-functioning AVF were enrolled. Complications included stenosis and thrombosis as well as hemodynamics parameters were examined by high-resolution B-mode ultrasonograph. The clinical and biochemical characteristics were performed. The related data were analyzed between complication positive group and negative group. Results Latent complications in well-functioning AVF were detected in 39.02 % e-MHD patients. The dif- ferences of internal diameter （P=0.015）, blood flow （P=0.015） of feeding radial artery, flow velocity of end diastolic phase （P=0.038） and resistance index （P=0.009） were significant between complication positive group and negative group. While the differences of systolic blood pressure （P=0.042）, levels of serum pre-albumin （P=0.006）, highdensity lipoprotein cholesterol （HDL-c） （P=0.008） and serum phosphate （P=0.002） between two groups were apparent. In Logistic multiple regression analysis, higher serum phosphate level （P=0.017） were the risk factors for incidence of AVF complications, while lower pre-albumin （P=0.020） and lower HDL-c level （P=0.024） were the protective factors. Conclusions A considerable proportion of latent complications exists in e-MHD patients with well-functioning AVF. The atherosclerotic feeding radial artery may play a key role in incidence of AVF complications and access dysfunction. Management of hyperphosphatemia, improvement of malnutrition and dyslipidemia as well as better control of blood pressure were of significance to reduce incidence of access complications and to prolong AVF patency rates in e-MHD patients.