“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！
{2147300:JCXVFDMR}
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1.
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
