介入治疗后中心静脉再置管在血管通路功能障碍中的应用

Application of re-catheterization with interventional therapy in hemodialysis vascular dysfunction

目的探讨介入治疗后中心静脉再置管在血液透析患者血管通路功能障碍（HVAD）中的应用价值。方法前瞻性观察2012年4-6月四川大学华西医院肾脏内科长期血液透析患者出现HVAD,经临床症状、体征和螺旋CT三维血管成像技术（CTA）或彩色多普勒超声（CDU）检测证实为中心静脉狭窄或闭塞或血栓形成,在血管球囊扩张成形术治疗后进行狭窄中心静脉再置管。结果完成介入治疗后中心静脉再置管者9例。其中7例患者行带涤纶套导管再置入术,经颈内静脉入路3例,经颈外静脉4例。2例经股静脉行无涤纶套导管置入术。置管成功率为100%。所有患者术后透析的体外血流速大于300mL/min,无明显并发症发生。在半年随访期内,1例患者死亡于多器官功能衰竭,其余8例的导管功能良好。结论介入治疗后中心静脉再置管治疗血管通路衰竭的HVAD患者疗效显著,安全性好,值得临床推广。

Objective To evaluate the effects of central venous re-catheterization with interventional therapy for hemodialysis vascular access dysfunction（HVAD）.Methods Form April to June in 2012,long-term hemodialysis patients with HVAD who received interventional therapy were prospectively observed in the nephrology department of west China hospital of Sichuan university.Central venous stenosis,obstruction or thrombosis was confirmed via clinical futures with computerized topographic angiography（CTA）or color doppler ultrasound（CDU）,then digital subtraction angiography（DSA）-guided balloon angioplasty and re-catheterization were performed.Results Nine cases succeeded in re-catheterization following with DSA-guided balloon angioplasty.Cuffed catheters were implanted for 7cases,internal jugular veins were used as the sites of catheter implantation for 3cases,and external jugular veins were used for 4case.Other 2cases were performed femoral venous catheterization.The blood flow reached to300mL/min or above,no complications was presented.After 6months follow-up,one patient died from multiple organ failure,but the catheter function of other 8cases was good.Conclusion The interventional therapy with re-catheterization is recommended to be efficient and safe for severe HVAD patients.