B超引导下经皮腔内血管成形术治疗血液透析患者自体动静脉内瘘狭窄的疗效研究

Study on the efficacy of percutaneous transluminal angioplasty by B-ultrasound in the treatment of autologous arteriovenous fistula stenosis in hemodialysis patients

目的探讨B超引导下经皮腔内血管成形术(PTA)治疗血液透析患者自体动静脉内瘘(AVF)狭窄的效果。方法回顾性选取2019年1月至2021年3月在广东省农垦中心医院进行血液透析治疗后发生自体动静脉内瘘狭窄的103例慢性肾脏病患者。比较患者手术前后内瘘狭窄处内径和血流量、肱动脉血流量、静脉压和收缩期峰值速度(PSV)变化,术后3、6个月的通畅率及并发症发生率。结果93例(90.3%)患者B超下PTA术成功。术后患者的内瘘狭窄出内径、透析泵控血流和肱动脉血流量分别为(3.65±0.47)mm、(249.5±25.4)mL/min、(986.9±191.7)mL/min,均较术前[(1.59±0.39)mm、(105.5±21.6)mL/min、(335.6±174.3)mL/min]显著增加,而术后患者的静脉压和PSV为(98.9±14.8)mmHg、(272.8±130.7)cm/s,均较术前[(179.9±15.1)mmHg、(415.6±152.4)cm/s]显著降低,差异均有统计学意义(P<0.05)。首次B超引导下PTA术后3、6个月的内瘘通畅率分别为94.2%(97/103)和85.4%(88/103),手术并发症发生率为4.85%(5/103)。结论B超引导下PTA治疗血液透析患者AVF狭窄安全有效。

Objective To investigate the effect of percutaneous transluminal angioplasty(PTA)guided by B-ultrasound in the treatment of autologous arteriovenous fistula(AVF)stenosis in hemodialysis(HD)patients.Methods One hundred and three patients with chronic kidney disease who developed autologous arteriovenous fistula stenosis after HD treatment in Guangdong Provincial Nongken Central Hospital from January 2019 to March 2021 were retrospectively selected.The changes of internal diameter and blood flow,venous pressure,brachial artery blood flow and peak systolic velocity(PSV)of internal fistula stenosis were compared before and after operation,the patency rate at 3 and 6 months after operation,and the incidence of postoperative complications.Results 93 cases(90.3%)of the patients were successfully treated with PTA by B-ultrasound.The internal diameter of internal fistula stenosis,the blood flow of internal fistula,and the blood flow of the brachial artery after operation were(3.65±0.47)mm,(249.5±25.4)mL/min,and(986.9±191.7)mL/min,respectively,which were significantly higher than preoperative[(1.59±0.39)mm,(105.5±21.6)mL/min,(335.6±174.3)mL/min],while the postoperative patient's venous pressure and PSV were(98.9±14.8)mmHg,(272.8±130.7)cm/s,which were significantly lower than preoperative[(179.9±15.1)mmHg,(415.6±152.4)cm/s],and the differences were statistically significant(P<0.05).The patency rates of internal fistula 3 months and 6 months after the first PTA by B-ultrasound were 94.2%(97/103)and 85.4%(88/103),respectively.No serious complications such as vascular rupture occurred during the operation,and the incidence of postoperative complications was 4.85%.Conclusion PTA by the guidance of B-ultrasound is safe and effective in the treatment of AVF stenosis in patients with HD.