血液透析動靜脈瘻管阻塞因子之分析研究

隨著醫療科技進步，慢性疾病患者日益增多，而腎臟病患者亦有逐年增加趨勢，根據2014年台灣腎臟年報的統計，在治療模式選擇上，主要為血液透析和腹膜透析，目前尚無治癒方式，除非接受腎臟移植，但因移植併發症多，且腎臟來源不易，所以超過90％的病人還是必須接受透析治療來維持生命。血液透析和腹膜透析兩種，各有優缺點和適用條件，使用血液透析比率至2012年占89.7%，腹膜透析比率為10.3%(2014台灣腎病年報)。血液透析治療成為多數慢性尿毒症病患賴以生存的治療方式，透析病人的動靜脈瘻管功能不佳會直接使透析效果下降，病人的罹病率、死亡率、住院率都相對增加。本研究目的為探討高雄市某地區醫院，血液透析病患動靜脈瘻管阻塞因子之分析。運用病歷回顧方式，考慮的危險因子主要包括人口統計變項、疾病相關變項及血液檢驗變項，和動靜脈瘻管阻塞是否為顯著相關的變項，進一步分析抽菸、糖尿病、高血壓、血管種類、血管位置、透析中降壓、重插次數、HDL、LDL等，和動靜脈瘻管阻塞是否有顯著意義。研究結果顯示，在人口統計變項(年齡、糖尿病、高血壓、抽菸)、疾病相關變項(、血管種類、血管位置、透析中降血壓)及血液檢驗值(Hb、Albumin、Ca、Cr、BMI)等預測之相關因素對透析動靜脈瘻管阻塞具有顯著相關。期望未來改善動靜脈瘻管阻塞及降低重建率，合理使用健保資源並降低更多醫療社會成本的耗費。並可提供臨床照護措施的指引，及未來研究上的參考。

關鍵字

血液透析；動靜脈瘻管阻塞；末期腎臟衰竭

並列摘要

As medical technology advances an increasing number of patients with chronic disease, and kidney disease also increased year by year, according to the 2014 Annual Statistical Taiwan kidneys, and in the choice of treatment modalities, primarily for hemodialysis and peritoneal dialysis, there is no way to cure unless receiving a kidney transplant, but the transplant complications and kidney source is not easy, so more than 90% of patients still must receive dialysis to sustain life. Two kinds of peritoneal dialysis and hemodialysis, have advantages and disadvantages and conditions, the use of hemodialysis ratio to 2012 accounted for 89.7%, 10.3% ratio of peritoneal dialysis (kidney Taiwan 2014 Annual Report). Hemodialysis treatment to become the majority of patients with chronic uremia survival of dialysis patients arteriovenous fistula dysfunction directly dialysis effect is reduced, morbidity, mortality, hospitalization of patients are relatively increased. This study was aimed to investigate an area hospital in Kaohsiung, hemodialysis patients with arteriovenous fistula factor analysis of the obstruction. Using chart review mode, the main risk factors to consider include Renkoutongji variables, disease-related variables and blood test variables, and arteriovenous fistula occlusion whether significant related variables, further analysis of smoking, diabetes, high blood pressure, type, vascular location, dialysis blood pressure, re-insert the number, HDL, LDL, etc., and arteriovenous fistula obstruction if there is significant meaning. The results show that in Renkoutongji variables (age, diabetes, hypertension, smoking) , disease-related variables ( vascular species , vessel position , dialysis blood pressure ) and blood test values (Hb, Albumin, Ca, Cr related factors BMI) and other predictive of dialysis arteriovenous fistula occlusion have significant correlation . Expected to improve future arteriovenous fistula obstruction and reduce the rate of reconstruction, the rational use of resources and reduce health care costs consume more health care community. And measures to provide clinical care guidelines, and reference study on the future.