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护理学报 ›› 2024, Vol. 31 ›› Issue (10): 59-63.doi: 10.16460/j.issn1008-9969.2024.10.059

• 调查研究 • 上一篇    下一篇

306例维持性血液透析患者自体动静脉内瘘穿刺部位瘤样扩张现状及影响因素分析

路景画1a,2, 陶惠琴1b, 张洁婷3, 刘爱群4, 陈景盈1a,2, 陈剑敏1b, 周宏珍1a,2   

  1. 1.南方医科大学南方医院 a.护理部;b.肾内科血液净化中心,广东 广州 510515;
    2.南方医科大学 护理学院,广东 广州 510515;
    3.广东省中医院大学城医院 透析科,广东 广州 510006;
    4.南方医科大学第三附属医院 血液净化中心,广东 广州 510630
  • 收稿日期:2023-11-20 出版日期:2024-05-25 发布日期:2024-06-06
  • 通讯作者: 周宏珍（1965-）,女,江苏扬州人,博士,博士研究生导师,主任护师。E-mail:zhouhz _smu@126.com
  • 作者简介:路景画（1997-）,女,河南洛阳人,本科学历,硕士研究生在读,护士。
  • 基金资助:
    中华医学会杂志社2022-2023年护理学科研究课题（CMAPH-NRI2022061）

Current status of aneurysmal dilatation at puncture segment of arteriovenous fistula in maintenance hemodialysis patients and its influencing factors: a 306-case study

LU Jing-hua1a,2, TAO Hui-qin2b, ZHANG Jie-ting3, LIU Ai-qun4, CHEN Jing-ying1a,2, CHEN Jian-min1b, ZHOU Hong-zhen1a,2   

  1. 1a. Dept. of Nursing Administration; 1b. Hemodialysis Center of Department of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China;
    2. School of Nursing, Southern Medical University, Guangzhou 510515, China;
    3. Dept. of Hemodialysis, University Village Hospital, Guangdong Provincial of Traditional Chinese Medicine, Guangzhou 510006, China;
    4. Hemodialysis Center, the Third Affiliated Hospital of Southern Medical University, Guangzhou 510630, China
  • Received:2023-11-20 Online:2024-05-25 Published:2024-06-06

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摘要： 目的 调查306例维持性血液透析患者自体动静脉内瘘穿刺部位瘤样扩张现状,并分析其影响因素。方法 采取便利抽样法,于2022年9月—2023年3月选取广州市3所三级甲等医院的306例维持性血液透析患者作为研究对象,根据自体动静脉内瘘是否发生穿刺部位瘤样扩张,分为瘤样扩张组（n=37）与非瘤样扩张组（n=269）,采用二分类Logistic回归分析穿刺部位瘤样扩张的影响因素。结果 306例维持性血液透析患者自体动静脉内瘘穿刺处瘤样扩张发生率为12.1%。二分类Logistic回归分析结果显示,内瘘使用时长>32个月、有区域穿刺史、肱动脉血流量>1 200 mL/min和吻合口直径>4 mm是自体动静脉内瘘穿刺部位瘤样扩张的危险因素（P<0.05）。结论 内瘘使用时间较长、有区域穿刺史、肱动脉血流量较高及吻合口直径较大是维持性血液透析患者自体动静脉内瘘穿刺部位瘤样扩张的危险因素。建议血液净化护理人员应避免区域穿刺,重点关注使用时间较长、肱动脉脉血流量较高及吻合口直径较大的内瘘,并针对性采取预防或应对措施,以最大限度延缓穿刺部位瘤样扩张的发生发展。

关键词: 维持性血液透析, 自体动静脉内瘘, 穿刺部位, 瘤样扩张

Abstract: Objective To investigate the current status of aneurysmal dilatation at the puncture segment of arteriovenous fistula in 306 maintenance hemodialysis patients and to analyze its influencing factors. Methods Using convenience sampling, 306 maintenance hemodialysis patients were selected from three tertiary grade-A hospitals in Guangzhou from September 2022 to March 2023. They were divided into aneurysmal dilatation group (n=37) and non-aneurysmal dilatation group (n=269) according to whether aneurysmal dilatation occurred in the puncture segment of arteriovenous fistula. The binary logistic regression was used to analyze the risk factors of aneurysmal dilatation of puncture segment. Results The incidence of aneurysmal dilatation at the puncture segment of arteriovenous fistula was 12.1% in 306 maintenance hemodialysis patients. Binary logistic regression analysis showed that fistula duration longer than 32 months, a history of area puncture, brachial artery flow greater than 1200 ml/min and anastomotic diameter greater than 4mm were risk factors for aneurysmal dilatation at the puncture segment of arteriovenous fistula in maintenance hemodialysis patients（P<0.05）. Conclusion Longer fistula duration, the history of area puncture, higher blood flow of brachial artery and larger anastomotic diameter are major risk factors for aneurysmal dilatation at the puncture segment of arteriovenous fistula. It is suggested that blood purification nurses should avoid area puncture, focus on the fistula with long duration of use, high brachial artery blood flow and large anastomotic diameter, and take targeted preventive or reactive measures to delay the development of aneurysmal dilatation at the puncture segment.

Key words: maintenance hemodialysis, arteriovenous fistula, puncture segment, aneurysmal dilatation

中图分类号: 

  • R473.5
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