背景:台灣末期腎臟病患者多數選擇血液透析，而血管通路是執行長期血液透析必要的處置。維持良好的血管通路可以提昇患者透析照護及減少醫療負擔。
目的:本研究旨在探討血液透析患者的血管通路使用時間及其相關因素。
方法:採回溯性世代研究，收集2010年至2017年中部某區域醫院血液透析室病患的病歷資料。資料包括病人基本特性、瘻管類型、開始使用血管通路與重建的時間，及血液檢查生理指標等。血管通路使用時間定義為開始使用至發生重建之時間區間。採Kaplan-Meier方法來評估自體瘻管與人工血管之血管通路使用時間長度，並以Cox迴歸分析影響血管通路使用時間的相關因子。
結果: 111位患者中，使用自體瘻管者佔多數(77.4%)。雙變項分析顯示，使用自體瘻管者相較於使用人工血管者，男性較多、糖尿病比率較低、血糖值較低、肌酸酐較高、鉀離子較高(p<0.05)。Kaplan-Meier分析顯示，使用自體瘻管者的血管通路使用時間中位數超過92.9月，顯著高於人工血管患者的12.6月(p<0.001)。Cox迴歸分析亦顯示不同瘻管類型的血管通路使用時間有顯著差異(HR=3.78, p<0.001)。
結論: 瘻管類型是血管通路使用時間的重要相關因子。建議在患者條件允許下，優先考慮採自體動靜脈瘻管，以延長血管通路使用時間。
Background: Most patients with end-stage renal disease in Taiwan choose hemodialysis. A vascular access is necessary for long-term hemodialysis treatment. Maintaining vascular access in well conditions could improve patients' dialysis care and reduce medical burden.
Purpose: The purpose of this study was to investigate the survival time of vascular access and its related factors in hemodialysis patients.
Methods: In this retrospective cohort study, we collected data of hemodialysis patients from medical records of a regional hospital in Taichung between 2010 and 2017. The data included patients’ characteristics, type of fistula, survival time of the fistula, and indicators of blood examination. Survival time of a fistula was defined as the time interval between the start of using and the reconstruction of it. Kaplan-Meier method was adopted to assess survival time of autologous and artificial fistulas, and Cox regression analysis was conducted to explore associated factors with the survival time.
Result: The data consisted of 111 patients. Most of them (77.4%) used autologous fistulas. Bivariate analyses showed that there were more males, lower prevalence of diabetes, lower blood glucose levels, and higher levels of creatinine and potassium among patients with autologous fistulas, compared to those using artificial fistulas (p <0.05). Kaplan-Meier analysis showed that the estimated median survival time of autologous fistulas was longer than 92.9 months, which was significantly greater than it of artificial fistulas (12.6 months) with p-value <0.001. Cox regression analysis also showed that there was a difference between the two types of fistulas in their survival time (Hazard ratio = 3.78, p <0.001).
Conclusion: The type of fistulas was important factor associated with the survival time of vascular access. The autologous fistula should be recommended in order to have longer survival time of the fistula, provided that the condition of a patient is accommodated.
