血液透析患者的动静脉瘘与指端灌注不足缺血综合征

Arteriovenous fistulas and digital hypoperfusion ischemic syndrome in patients on hemodialysis.

作者信息

Stolic Radojica V, Trajkovic Goran Z, Miric Dijana J, Kisic Bojana, Djordjevic Zorana, Azanjac Goran Lj, Stanojevic Marijana S, Stolic Dragica Z

机构信息

Radojica V Stolic, Goran Z Trajkovic, Dijana J Miric, Bojana Kisic, Medical Faculty, University of Pristina, 38220 Kosovska Mitrovica, Serbia.

出版信息

World J Nephrol. 2013 May 6;2(2):26-30. doi: 10.5527/wjn.v2.i2.26.

DOI:10.5527/wjn.v2.i2.26

PMID:24175262

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC3782223/

Abstract

AIM

To determine survival parameters as well as characteristics of patients with this syndrome.

METHODS

The investigation was conducted over a period of eight years, as a prospective, non-randomized, clinical study which included 204 patients, treated by chronic hemodialysis. Most patients received hemodialysis 12 h per week. As vascular access for hemodialysis all subjects had an arteriovenous fistulae. Based on surveys the respondents were divided into groups of patients with and without digital hypoperfusion ischemic syndrome. Gender, demographic and anthropometric characteristics, together with comorbidity and certain habits, were recorded. During this period 34.8% patients died.

RESULTS

Patients with digital hypoperfusion ischemic syndrome were older than those without ischemia (P = 0.01). Hemodialysis treatment lasted significantly longer in the patients with digital hypoperfusion ischemic syndrome (P = 0.02). The incidence of cardiovascular disease (P < 0.001) and diabetes mellitus (P = 0.01), as well as blood flow through the arteriovenous fistula (P = 0.036), were higher in patients with digital hypoperfusion ischemic syndrome. Statistically significant differences also existed in relation to oxygen saturation (P = 0.04). Predictive parameters of survival for patients with digital hypoperfusion ischemic syndrome were: adequacy of hemodialysis (B = -3.604, P < 0.001), hypertension (B = -0.920, P = 0.018), smoking (B = -0.901, P = 0.049), diabetes mellitus (B = 1.227, P = 0.005), erythropoietin therapy (B = 1.274, P = 0.002) and hemodiafiltration (B = -1.242, P = 0.033). Kaplan-Meier survival analysis indicated that subjects with and without digital hypoperfusion ischemic syndrome differed regarding the length of survival (P < 0.001), i.e., patients with confirmed digital hypoperfusion ischemic syndrome died earlier.

CONCLUSION

Survival was significantly longer in the patients without digital hypoperfusion ischemic syndrome.

摘要

目的

确定该综合征患者的生存参数以及特征。

方法

这项研究为期八年，是一项前瞻性、非随机的临床研究，纳入了204例接受慢性血液透析治疗的患者。大多数患者每周接受12小时的血液透析。所有受试者均以动静脉内瘘作为血液透析的血管通路。根据调查，将受访者分为患有和未患有指端灌注不足缺血综合征的患者组。记录性别、人口统计学和人体测量学特征，以及合并症和某些习惯。在此期间，34.8%的患者死亡。

结果

患有指端灌注不足缺血综合征的患者比未患有缺血的患者年龄更大（P = 0.01）。指端灌注不足缺血综合征患者的血液透析治疗持续时间明显更长（P = 0.02）。指端灌注不足缺血综合征患者的心血管疾病（P < 0.001）和糖尿病（P = 0.01）发病率以及通过动静脉内瘘的血流量（P = 0.036）更高。在血氧饱和度方面也存在统计学显著差异（P = 0.04）。指端灌注不足缺血综合征患者生存的预测参数为：血液透析充分性（B = -3.604，P < 0.001）、高血压（B = -0.920，P = 0.018）、吸烟（B = -0.901，P = 0.049）、糖尿病（B = 1.227，P = 0.005）、促红细胞生成素治疗（B = 1.274，P = 0.002）和血液透析滤过（B = -1.242，P = 0.033）。Kaplan-Meier生存分析表明，患有和未患有指端灌注不足缺血综合征的受试者在生存时长方面存在差异（P < 0.001），即确诊患有指端灌注不足缺血综合征的患者死亡更早。