高压球囊扩张术联合溶栓治疗老年MHD患者AVF的疗效及安全性

Curative effect and safety of high-pressure balloon dilatation combined with thrombolysisin elderly patients with AVF stenosisundergoing MHD

目的观察高压球囊扩张术联合溶栓治疗老年维持性血液透析(MHD)患者动静脉内瘘(AVF)狭窄的疗效及安全性。方法选取2019年2月至2021年2月于自贡市第一人民医院治疗的76例老年MHD患者,采用数字表法随机分为对照组(药物溶栓治疗)和观察组(溶栓联合高压球囊扩张术治疗),每组各38例,随访半年,比较两组患者的临床疗效、内瘘血流量、血管内径和狭窄处峰值流速,以及术后不同时间(术后1个月、3个月、半年)AVF通畅率,记录两组患者并发症和再狭窄发生情况。结果观察组的治疗有效率为94.74%,高于对照组的78.95%(P<0.05);术后观察组的内瘘血流量、血管内径高于对照组,狭窄处峰值流速低于对照组(P<0.05);术后3个月、半年,观察组的初级通畅率、次级通畅率分别为84.21%、94.74%,78.95%、76.32%,均高于对照组的63.16%、78.95%,55.26%、52.63%,差异有统计学意义(P<0.05);两组患者术后并发症发生率比较,差异无统计学意义(P>0.05);观察组的再狭窄发生率为5.26%,低于对照组的23.68%,差异有统计学意义(P<0.05)。结论溶栓联合高压球囊扩张术治疗老年MHD患者AVF狭窄疗效良好,可有效提高透析流量和通畅率,降低再狭窄发生率。

Objective To observe the curative effect of high-pressure balloon dilatation combined with thrombolysison arteriovenous fistula(AVF)stenosis in elderly patients undergoing maintenance hemodialysis(MHD)and assess itssafety.Methods A total of 76 elderly patients undergoing MHD in Zigong First People’s Hospitalwere enrolled between February 2019 and February 2021.According to random number table method,they were divided into control group(thrombolysis)and observation group(thrombolysis combined with high-pressure balloon dilatation),with 38 cases in each group.All were followed up for half a year.The clinical curative effect,blood flow volume of internal fistula,vascular diameter and peak systolic velocity at stenosis site,and patency rates of AVF at different time points(1 month,3 months and half a year after surgery)were compared between the two groups.The occurrence of complications and re-stenosis in both groups was recorded.Results The response rate of treatment inobservation group was higher than that in control group(94.74%vs 78.95%)(P<0.05).After surgery,blood flow volume of internal fistula and vascular diameter in observation group were higher than those in control group,while peak systolic velocity at stenosis site was slower than that in control group(P<0.05).Three months and half a year after surgery,primary patency and secondary patency rates in the observation group were 84.21%,94.74%,78.95%and 76.32%,higher than those in control group(63.16%,78.95%,55.26%,52.63%)(P<0.05).There was no significant difference in the incidence of postoperative complications between the two groups(P>0.05).The incidence of re-stenosis in theobservation group was lower than that in the control group(5.26%vs 23.68%)(P<0.05).Conclusions The curative effect of thrombolysis combined with high-pressure balloon dilatation is good on AVF stenosis in elderly patients undergoing MHD,which can effectively improve dialysis flow and patency rate,and reduce the incidence of re-stenosis.