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Logistic regression analysis of risk factors for hematoma after autologous arteriovenous fistula in hemodialysis patients.

Logistic regression analysis of risk factors for hematoma after autologous arteriovenous fistula in hemodialysis patients.

机构信息

Department of Blood Purification Room, Lianyungang TCM Hospital Affiliated to Nanjing University of Chinese Medicine, Lianyungang, Jiangsu, China.

Department of Operating Room, The Second People's Hospital of Lianyungang, Lianyungang, Jiangsu, China.

出版信息

Medicine (Baltimore). 2024 Jan 12;103(2):e36890. doi: 10.1097/MD.0000000000036890.

Abstract

To determine the risk factors and nursing countermeasures for post-operative hematoma in hemodialysis patients with autogenous arteriovenous fistula by logistic regression analysis. A retrospective analysis of 240 chronic hemodialysis patients admitted to our hospital from January 2019 to October 2022 was performed. Physical and vascular examinations of the patients were performed by surgeons. Continuous care measures were implemented for all patients. The patient serum creatinine (Scr) and blood urea nitrogen (BUN) were measured on the day of inclusion and after the implementation of care measures. Self-management scales were used to analyze patients' self-management. Fatigue symptoms were assessed using the Fatigue Scale 14. The WHO Quality of Life Scale (WHOQOL-BREF score) was used to assess patients' quality of life. Self-Rating Depression Scale and Self-Rating Anxiety Scale (SAS) were used to assess negative affect. Treatment compliance was assessed according to 3 levels: complete compliance, compliance, and noncompliance. In all, 240 patients underwent 240 initial and 48 repeat procedures; 18 of the 240 patients experienced fistula failure, with an overall success rate of 92.5% (222/240). There were no significant differences in renal function, self-management, General Self-Efficacy Scale, fatigue symptom scores, and WHOQOL-BREF scores between the postoperative hematoma group and no-hematoma group before the continuous care. After continuous care, renal function, self-management, General Self-Efficacy Scale, fatigue symptom scores, and WHOQOL-BREF scores were better in the postoperative no-hematoma group than in the hematoma group, and the difference was statistically significant (P < .05). Logistic regression analysis of risk factors for postoperative hematoma showed that elevated Scr and BUN levels, decreased self-management and SAS scores and poor treatment compliance were independent risk factors for postoperative hematoma in hemodialysis patients with autologous arteriovenous fistulas (P < .05). Elevated Scr levels, elevated BUN levels, decreased self-management scores, decreased SAS scores, and poor treatment compliance were independent risk factors for postoperative hematoma in hemodialysis patients with autogenous arteriovenous fistulas. By providing continuous care to hemodialysis patients based on timing theory, the negative emotions can be alleviated and the self-efficacy, quality of life, and treatment compliance of the patients can be improved.

摘要

通过 logistic 回归分析确定自体动静脉内瘘血液透析患者术后血肿的危险因素和护理对策。回顾性分析 2019 年 1 月至 2022 年 10 月我院收治的 240 例慢性血液透析患者,由外科医生对患者进行体格检查和血管检查。对所有患者实施持续护理措施。在纳入当天和实施护理措施后测量患者的血清肌酐(Scr)和血尿素氮(BUN)。采用自我管理量表分析患者的自我管理情况。采用疲劳量表 14 评估患者的疲劳症状。采用世界卫生组织生活质量量表(WHOQOL-BREF 评分)评估患者的生活质量。采用抑郁自评量表和焦虑自评量表(SAS)评估负性情绪。根据完全依从、依从和不依从 3 个水平评估治疗依从性。共 240 例患者行 240 次初次手术和 48 次重复手术;240 例患者中 18 例发生内瘘失败,总体成功率为 92.5%(222/240)。在连续护理前,术后血肿组和无血肿组患者的肾功能、自我管理、一般自我效能感量表、疲劳症状评分和 WHOQOL-BREF 评分无统计学差异。连续护理后,术后无血肿组患者的肾功能、自我管理、一般自我效能感量表、疲劳症状评分和 WHOQOL-BREF 评分均优于血肿组,差异有统计学意义(P<0.05)。自体动静脉内瘘血液透析患者术后血肿的危险因素的 logistic 回归分析显示,Scr 和 BUN 水平升高、自我管理和 SAS 评分降低、治疗依从性差是自体动静脉内瘘血液透析患者术后血肿的独立危险因素(P<0.05)。Scr 水平升高、BUN 水平升高、自我管理评分降低、SAS 评分降低、治疗依从性差是自体动静脉内瘘血液透析患者术后血肿的独立危险因素。基于时间理论为血液透析患者提供连续护理,可以减轻其负性情绪,提高其自我效能、生活质量和治疗依从性。

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