학술논문
维持性血液透析患者内瘘侧上肢功能障碍及影响因素的研究 / The dysfunction of upper limb at the arteriovenous fistula or graft side and its influencing factors in maintenance hemodialysis patients
Document Type
Academic Journal
Author
王欣欣; 孙超; 黎爽; 郑涵絮; 顾国燕; 宋晓朵; 于海艳; 尹咏梅; 吴海虹; 田欣; 管月红; 尚云霄; 赵爽; 黄富表; 马迎春; WANG Xin-xin; SUN Chao; LI Shuang; ZHENG Han-xu; GU Guo-yan; SONG Xiao-duo; YU Hai-yan; YIN Yong-mei; WU Hai-hong; TIAN Xin; GUAN Yue-hong; SHANG Yun-xiao; ZHAO Shuang; HUANG Fu-biao; MA Ying-chun
Source
中国血液净化 / Chinese Journal of Blood Purification. 23(1):53-61
Subject
Language
Chinese
ISSN
1671-4091
Abstract
目的 评估维持性血液透析(maintenance hemodialysis,MHD)动静脉内瘘右利手患者的双侧上肢功能,了解动静脉内瘘对上肢功能的影响及内瘘侧上肢功能的影响因素.方法 横断面研究,纳入北京市6家血液透析中心的MHD动静脉内瘘且右利手患者,收集人口学资料、生化资料、握力、关节活动度及简易上肢功能检查(simple test for evaluating hand function,STEF)等上肢功能指标.内瘘侧及非内瘘侧上肢功能的比较采用t检验(或非参数检验),采用多元线性回归分析MHD患者动静脉内瘘侧握力的影响因素.结果 共入组MHD患者90例,其中男性51例(56.7％),年龄(59.63±10.60)岁,中位透析龄62.50(24.00,113.00)月.患者非内瘘侧握力高于内瘘侧握力(t=-5.133,P＜0.001);多元线性回归结果显示MHD患者内瘘侧握力与血肌酐(冷=0.353,P＜0.001)、认知功能评分(β=0.223,P=0.006)呈正相关,与尿素清除指数(Kt/V)呈负相关(p=-0.235,P=0.007),男性握力大于女性(β=-0.253,P=0.004).非内瘘侧腕关节尺偏的角度大于内瘘侧(t=-2.814,P=O.006).在STEF各项操作中,内瘘侧在大球(t=2.327,P=0.021)、大圆片(t=2.472,P=0.015)、布(t=2.688,P=O.008)项目中操作时间长于无内瘘侧.结论 MHD患者内瘘侧握力、关节活动度及灵活性均存在下降,影响内瘘侧握力的因素包括性别、血肌酐、Kt/V和认知功能评分.
Objective To evaluate the function of both upper limbs in right-handed maintenance hemodi-alysis(MHD)patients with arteriovenous fistula or graft for blood access,and to understand the influence of arteriovenous fistula or graft on upper limb function and the factors influencing the limb function at arteriove-nous fistula or graft side.Method This was a cross-sectional study.Right-handed patients with arteriovenous fistula or graft from six hemodialysis centers in Beijing were enrolled.Demographic,biochemical data and up-per limb function indexes including grip strength,range of joint motion,and Simple Test for Evaluating Hand Function(STEF)were collected.t test or non-parametric test was used to compare the upper limb function of arteriovenous fistula or graft side and non-fistula or graft side.Multivariate linear regression was used to ana-lyze the influencing factors for grip strength at the arteriovenous fistula or graft limb side in MHD patients.Results A total of 90 MHD patients were enrolled,51(56.7％)of the patients were males,the mean age was 59.63±10.60 years,and the median dialysis vintage was 62.50(24.00,113.00)months.The grip strength of non-fistula or graft side was higher than that of fistula or graft side(23.03±10.77 vs.20.66±10.52,t=-5.133,P＜0.001).Multivariate linear regression demonstrated that the grip strength at fistula or graft side was posi-tively correlated to serum creatinine(β=0.353,P＜0.001)and cognitive function(β=0.223,P=0.006),and was negatively correlated to urea clearance index(Kt/V)(β=0.235,P=0.007).The grip strength at fistula or graft side was higher in males than in females(β=-0.253,P=0.004).The motion range of carpal joint turned to ulnar side was greater in the non-fistula or graft limb than that in the fistula or graft limb(32.85±10.81 vs.29.92± 9.46,t=-2.814,P=0.006).In the STEF tests,the operation time for large ball(8.17±1.78 vs.7.99±1.78,t=2.327,P=0.021),large disc(7.29±1.91 vs.7.02±1.84,t=2.472,P=0.015)and cloth(7.36±2.06 vs.7.13±1.84,t=2.688,P=0.008)were longer in the fistula or graft side than those in the non-fistula or graft side,with the dif-ferences reached statistical significances(P＜0.05).Conclusions The grip strength,range of joint motion and flexibility were decreased in the fistula or graft side.The factors affecting the grip strength in fistula or graft side included gender,serum creatinine,Kt/V and cognitive function.
Objective To evaluate the function of both upper limbs in right-handed maintenance hemodi-alysis(MHD)patients with arteriovenous fistula or graft for blood access,and to understand the influence of arteriovenous fistula or graft on upper limb function and the factors influencing the limb function at arteriove-nous fistula or graft side.Method This was a cross-sectional study.Right-handed patients with arteriovenous fistula or graft from six hemodialysis centers in Beijing were enrolled.Demographic,biochemical data and up-per limb function indexes including grip strength,range of joint motion,and Simple Test for Evaluating Hand Function(STEF)were collected.t test or non-parametric test was used to compare the upper limb function of arteriovenous fistula or graft side and non-fistula or graft side.Multivariate linear regression was used to ana-lyze the influencing factors for grip strength at the arteriovenous fistula or graft limb side in MHD patients.Results A total of 90 MHD patients were enrolled,51(56.7％)of the patients were males,the mean age was 59.63±10.60 years,and the median dialysis vintage was 62.50(24.00,113.00)months.The grip strength of non-fistula or graft side was higher than that of fistula or graft side(23.03±10.77 vs.20.66±10.52,t=-5.133,P＜0.001).Multivariate linear regression demonstrated that the grip strength at fistula or graft side was posi-tively correlated to serum creatinine(β=0.353,P＜0.001)and cognitive function(β=0.223,P=0.006),and was negatively correlated to urea clearance index(Kt/V)(β=0.235,P=0.007).The grip strength at fistula or graft side was higher in males than in females(β=-0.253,P=0.004).The motion range of carpal joint turned to ulnar side was greater in the non-fistula or graft limb than that in the fistula or graft limb(32.85±10.81 vs.29.92± 9.46,t=-2.814,P=0.006).In the STEF tests,the operation time for large ball(8.17±1.78 vs.7.99±1.78,t=2.327,P=0.021),large disc(7.29±1.91 vs.7.02±1.84,t=2.472,P=0.015)and cloth(7.36±2.06 vs.7.13±1.84,t=2.688,P=0.008)were longer in the fistula or graft side than those in the non-fistula or graft side,with the dif-ferences reached statistical significances(P＜0.05).Conclusions The grip strength,range of joint motion and flexibility were decreased in the fistula or graft side.The factors affecting the grip strength in fistula or graft side included gender,serum creatinine,Kt/V and cognitive function.