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中国护理管理 ›› 2026, Vol. 26 ›› Issue (2): 183-189.doi: 10.3969/j.issn.1672-1756.2026.02.005

• 特别策划·血液透析管理 • 上一篇    下一篇

维持性血液透析患者自体动静脉内瘘功能的影响因素分析

赵微微 金玮艺 杨春艳 罗莉 刘进进 苏春燕   

  1. 北京大学第三医院肾内科，100191 北京市（赵微微，苏春燕）；护理部（金玮艺）；北京市垂杨柳医院血液净化中心（杨春艳）；北京大学国际医院透析室（罗莉）；首都医科大学附属复兴医院肾内科（刘进进）
  • 出版日期:2026-02-15 发布日期:2026-02-15
  • 通讯作者: 苏春燕，博士，主任护师，护理部副主任，硕士生导师，E-mail:scybmu@126.com
  • 作者简介:赵微微，本科，主管护师，护士长
  • 基金资助:
    北京大学第三医院临床重点项目孵育项目B类（BYSYZD2022037）

Influencing factors of Autologous arteriovenous Fistula function in Maintenance Hemodialysis patients

ZHAO Weiwei, JIN Weiyi, YANG Chunyan, LUO Li, LIU Jinjin, SU Chunyan   

  1. Department of Nephrology, Peking University Third Hospital, Beijing, 100191, China
  • Online:2026-02-15 Published:2026-02-15
  • Contact: E-mail:scybmu@126.com

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摘要： 目的：分析维持性血液透析（Maintenance Hemodialysis，MHD）患者自体动静脉内瘘（Autologous arteriovenous Fistula，AVF）功能的影响因素，为临床制定个体化内瘘保护策略提供依据。方法：本研究为前瞻性队列研究，于2023年5月至2024年1月便利选取北京市4家医院中以AVF作为血管通路的MHD患者，收集患者人口学特征、原发病、透析相关资料、实验室指标及AVF评估数据，随访至2025年10月。采用单因素分析、多因素Cox比例风险模型筛选AVF功能的影响因素。结果：共纳入231例患者，平均随访时间为（21.05±7.72）个月。截至2025年10月，失访31例，发生AVF功能障碍40例。多因素Cox比例风险回归分析显示，透析龄较长（HR=0.850，P=0.005）、使用高通量血滤器（HR=0.329，P=0.049）、总胆固醇水平较高（HR=0.663，P=0.047）及触诊评分较高（HR=0.567，P=0.006）是AVF功能的保护因素；AVF非首次建立（HR=4.970，P=0.003）和有AVF干预史（HR=2.545，P=0.012）是危险因素。Kaplan-Meier生存曲线分析显示，物理评估触诊评分与AVF通畅率呈负相关（Log Rank χ2=105.534，P<0.001），以3分为界值可有效区分高、低风险患者。结论：透析龄、血滤器类型、AVF建立次数、AVF干预史、总胆固醇水平及触诊评分是MHD患者AVF功能的影响因素，触诊评分可作为便捷的床旁预测工具，为临床早期干预和个体化管理提供依据。

关键词: 血液透析；自体动静脉内瘘；功能障碍；影响因素；队列研究

Abstract: Objective: To analyze the influencing factors for Autologous arteriovenous Fistula (AVF) dysfunction in Maintenance Hemodialysis (MHD) patients, and to provide evidence for formulating individualized AVF protection strategies. Methods: A prospective cohort study was adopted, MHD patients with AVF as the vascular access were recruited from 4 hospitals in Beijing from May 2023 and January 2024. We collected data, including patients' demographic characteristics, comorbidities, dialysis-related parameters, laboratory indices, and AVF assessment results from the beginning to October 2025 when the follow-up ended. Univariate analysis and multivariate Cox proportional hazards model were used to identify influencing factors for AVF function. Results: A total of 231 patients were enrolled, with a mean follow-up of 21.05±7.72 months. By October 2025, apart from the 31 patients being lost to follow-up, 40 patients developed AVF dysfunction. Multivariate Cox proportional hazards regression analysis showed that longer dialysis vintage (HR=0.850, P=0.005), use of high-flux dialyzers (HR=0.329, P=0.049), higher total cholesterol level (HR=0.663, P=0.047), and higher palpation score (HR=0.567, P=0.006) were protective factors against AVF dysfunction. As to risk factors, there were not newly created AVF (HR=4.970, P=0.003) and a history of AVF intervention (HR=2.545, P=0.012). Kaplan-Meier survival curves demonstrated a significant negative correlation between the palpation score and AVF patency rate (Log Rank χ2=105.534, P<0.001), with a cut-off value of 3 to effectively distinguish high-risk patients from low-risk patients. Conclusion: Dialysis vintage, type of dialyzers, number of AVF creations, history of AVF intervention, total cholesterol level, and palpation score were factors influencing AVF function in MHD patients. Moreover, the palpation scoring system may serve as a convenient bedside predictive tool, providing evidence for early clinical intervention and individualized management.

Key words: Maintenance Hemodialysis; Autogenous arteriovenous Fistula; dysfunction; influencing factor; cohort study

中图分类号:  R47；R197
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