血液透析患者動靜脈瘻管栓塞以經皮血管成形術和重建的相關因素探討

Evaluation the Related Factors between Percutaneous Transluminal Angioplasty and Surgical Reconstruction after the Vascular Access Failure

蕭妏倩(Wun-Cian Shiau)

指導教授 ： 丘周萍

義守大學/醫學院/醫務管理學系/碩士(2016年)

摘要

根據美國腎臟登錄系統（USRDS）2013年報公佈最新的全球尿毒症排行，台灣每年新增加洗腎病患比率（發生率）已由2007年最高峰的424/每百萬人口降至361/每百萬人口，而透析病患佔總人口比率（盛行率）仍居高不下，由2007年的2285上升為每百萬人口2584人，血液透析病患必須仰賴血管通路進行血液透析治療，對病患而言血管通路可視為第二條生命線，本研究目的在於當瘻管發生問題時先發處置為PTA與手術成本相關之衡量，適當訂定瘻管重建手術與PTA治療的標準，降低瘻管失效率及降低維持成本，合理化健保支出。研究工具為SPSS22.0繁體中文版進行資料統計以運用羅吉斯迴歸及卡方檢定，發現性別與經皮血管成形術(PTA)無顯著，年齡與透析齡、有糖尿病HbA1c＞5.5、人工血管(AVG)與動靜脈瘻管(AVF)栓塞比較、瘻管流速≦670cc/min較易栓塞，PTA(P＜0.05)是顯著的，所以，此數據在未來定期監測紀錄動靜瘻管血液流量，得以訂定重建手術與PTA的治療標準，能合理化醫療支出及展延瘻管壽命及提升生活品質。

關鍵字

尿毒症 ； 血液透析 ； 動靜脈瘻管 ； 經皮血管成形術 ； 糖尿病

並列摘要

According to the United States Renal Data System 2013 annual report ,the global rankings of dialysis patients incidence rate ratio of Taiwan annual (2007-2013), from 424 fell to 361/ per million people, but hemodialysis patients relative to the total population (prevalence rate) is still high. Hemodialysis patients are from 2285 in 2007 rose to 2584/ per million people. Hemodialysis patients mainly rely on vascular access for treatment, the vascular access can be regarded as the second lifeline of patient.
The purpose of this study was to explore the cost and timing between PTA and surgery reconstruction, and making an appropriate guideline for PTA and surgery reconstruction. The aim is to reduce the failure rate of fistula and the maintenance cost, the rationalization of the health care expenditure.
Statistical tool for this research is SPSS 22.0, according to the results using logistic regression and chi square test for gender and PTA are no significant, but age, diabetes (HbA1c＞5.5), the emboli of artificial vascular graft (AVG) and dynamic venous fistula tube (AVF), PTA cost is higher than rebuilding the fistula tube, fistula flow ≦670 cc/min easily embolism and PTA are significant (P＜0.05).
In the future, we will be regular to monitor and record the blood flow of A-V fistula, and making a guideline for the surgery reconstruction and PTA, provide the rationalization of medical expenditure and extension the Life expectancy of fistula and enhance the quality of patients life.

並列關鍵字

uremia ； hemodialysis ； A-V fistula ； percutaneous angioplasty (PTA) ； diabetes mellitus

參考文獻

李宗龍 (2015) •末期腎衰竭病人接受不同類型瘻管之療效及醫療資源使用(未發

林燕琴、謝炯昭 (2007) •慢性腎衰竭病人血管通路的手術前評估及術後照護。

林大維、楊五常 (2005)•慢性透析病人的心臟血管疾病•腎臟與透析，17，30-43

許智揚 (2008) • 透析病患血管通路的建立及維護。腎臟與透析，(20)，63-67

陳盈安、楊五常、林志慶 (2015)• 慢性腎臟病患者的透析血管通路建立時機及