目的 本研究将探究血液透析老年患者发生自体动静脉内瘘(arteriovenous fistula，AVF)成熟不良与衰弱的关系，为衰弱患者血管通路决策及干预提供依据。 方法 调查2019年1月─2023年12月在山西省汾阳医院首次行AVF成形术的血液透析老年患者。采用倾向性评分匹配(propensity score matching，PSM)控制混杂因素，并开展匹配后单因素分析，再应用修正Poisson回归分析进行效应估计。 结果 275例血液透析老年患者AVF手术前衰弱发生率为35.6%，AVF成熟不良发生率为27.3%。PSM后单因素分析得出：衰弱者发生AVF成熟不良与非衰弱者相比差异有统计学意义(χ2=9.341,P=0.002)。通过修正Poisson回归分析控制其他混杂因素后，进一步得出衰弱(RR=1.921，95% CI：1.302～2.835，P=0.001)是AVF成熟不良的独立危险因素。 结论 血液透析老年患者手术前衰弱发生率较高，且衰弱后发生AVF成熟不良的风险是非衰弱患者的1.9倍。应考虑手术前对老年人开展衰弱等老年综合评估，为长期性血管通路决策和干预提供依据。
Objective This study explored the relationship between maturation failure of autologous arteriovenous fistula (AVF) and frailty in elderly maintenance hemodialysis (MHD) patients to provide a basis for planning vascular access and intervention in frailty patients. Methods A total of 275 elderly patients undergoing AVF surgery in a hospital in Shanxi province from January 2020 to December 2023 were investigated. Propensity score matching (PSM) was used to control confounding factors, post-matching univariate analysis was performed, and then modified Poisson regression analysis was applied for effect estimation. Results The survey showed that the incidence of maturation failure was 27.3% and frailty was 35.6% in elderly MHD patients. Univariate analysis after PSM showed that the incidence of maturation failure in frail patients was significantly different compared to the non-frail patients (χ2=9.341, P=0.002). After controlling for other confounding factors by modified Poisson regression analysis, it was further concluded that frailty (RR=1.921, 95% CI:1.302～2.835, P=0.001) was an independent risk factor for AVF maturation failure. Conclusion The incidence of preoperative frailty was higher in elderly MHD patients. The risk of AVF maturation failure in frail patients was 1.9 times higher than that in non-frail patients. To provide a basis for long-term vascular access decision-making and intervention, comprehensive evaluation of the elderly before AVF surgery should be emphasized.
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