“醫生,是不是你們技術差啊?人家血管用好幾年都沒事,我們剛做好血管沒多久,為什麼就要我們去通血管啊?”
欸!每次聽到這種話,我就心裡不大舒服,護理人員小心翼翼的幫你打針,大家都戰戰兢兢,用心幫你打針,一來就說我們技術不好,未免也太…那個了吧!
這是一個70幾歲患者對我們說的,他抽菸抽了40-50年,是糖尿病引起腎臟衰竭,有高血壓,心臟也做過心導管,這樣的患者我們心裡有數,血管一定不會太好,所以,我要來查查文獻,看有沒有辦法未卜先知,在還沒做血管或打針之前,就先知道你的血管可能會很快壞掉。這是一篇2010年的文章,標題是:
有哪些危險因子,會導致血液透析的血管通路在“六個月之內”就塞住!
結果:
危險因子 | 危險指數 (95% CI) |
---|
初始血流速測量 <500 cc/min (使用超音波的方式) | 16 (11 to 26) |
抽菸(還在抽,或五年內有抽菸者) | 3.7 (2.2 to 5.9) |
患有糖尿病 | 2.5 (1.6 to 4.0) |
患有高血壓 | 2.5 (1.5 to 4.3) |
年紀≥65歲 | 2.4 (1.4 to 4.1) |
周邊血管疾病 | 2.4 (1.6 to 3.6) |
第一個危險因子,是使用超音波的方式,來測量血管內的血流速度,如果不到 500 cc/min,六個月內塞住的機會上升至16倍,這個檢查,不曉得哪裡有在做。其他因子裡面,最強烈相關的是抽菸,如果患者五年內仍有抽菸的習慣,機會上升到3.7倍。糖尿病、高血壓、年紀大於65歲等等,這些都是不意外的危險因素,就不再贅述。
回到本文剛開始的那位患者,他年紀大、有糖尿病、高血壓、又不戒菸,他血管六個月內停掉需要修理的機會,是正常的55倍!
本身血管條件就不好,我們打針技術再強,也無法保住您的血管。就如同狀況很差的老車,開車高手再厲害,也沒辦法保證車子都不會開壞掉。請把菸戒了、糖尿病控制好、血壓控制好,該保養血管的動作要做,這樣血管才會健康啦!
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Monroy-Cuadros M, Yilmaz S, Salazar-Bañuelos A, Doig C. Risk Factors Associated with Patency Loss of Hemodialysis Vascular Access within 6 Months.
CJASN. 2010;5(10):1787-1792.
http://doi.org/10.2215/CJN.09441209