超声下经皮腔内血管成形术治疗血液透析患者动静脉内瘘狭窄的效果观察

Observation of the effect of percutaneous transluminal angioplasty under ultrasound in treatment of arteriovenous fistula stenosis in hemodialysis patients

目的探讨超声引导下经皮腔内血管成形术(Peructaneoustransluminalangioplasty,PTA)治疗维持性血液透析患者动静脉内瘘狭窄的疗效。方法选取2020年6月—2022年6月在郑州市第三人民医院接受超声引导下皮腔内血管成形术的40例维持性血液透析动静脉内瘘患者为研究对象,由同一治疗团队对所有患者实施PTA,观察所有患者治疗成功率,比较治疗前后患者内瘘最窄处内径、内瘘自然流量和血液透析流量,并记录患者3个月、6个月、12个月不良反应发生情况。结果全组成功例数为39例,成功率达97.50%(39/40)。且术后患者血管最窄内径、内瘘自然流量和透析血流量均显著优于治疗前,差异具有统计学意义(P<0.05);所有患者均未出现严重并发症,仅2例患者术后创口出现局部肿胀,1例创口出血,且未经干预于术后4 d自行消退;术后3个月、6个月、12个月内瘘再狭窄发生率为5.00%(2/40)、15.00%(6/40)、27.50%(11/40)。结论超声引导下经皮腔内血管成形术具有创伤小、不良反应发生率低、缓解患者痛苦的优势,并能减少对患者和医护人员的辐射损害,具有较高的临床推广价值。

Objective To explore the ultrasound guided by the bellows in angioplasty(Peructaneoustransluminalangioplasty,PTA)in the treatment of maintenance hemodialysis patients with arteriovenous fistula stenosis of curative effect.Methods Forty patients with arteriovenous fistula undergoing ultrasound-guided intravascular angioplasty in Zhengzhou the Third People's Hospital from June 2020 to June 2022 were selected as the study objects.The same treatment team administered PTA to all patients,observed the treatment success rate of all patients,and compared the internal diameter of the narrowest internal fistula,the natural flow rate of internal fistula and blood before and after treatment The flow rate of fluid dialysis was recorded,and the occurrence of adverse reactions at 3 months,6 months and 12 months were recorded.Results There were 39 successful cases in the whole group,with a success rate of 97.50%(39/40).In addition,the narrowest inner diameter of blood vessels,natural flow of internal fistula and dialysis blood flow were significantly better than those before treatment,with statistical significance(P<0.05).No serious complications occurred in all patients.Only 2 patients experienced local swelling and 1 patient experienced wound bleeding,which resolved spontaneously on the 4th day after surgery without intervention.The incidence of fistula restenosis at 3,6 and 12 months after surgery was 5.00%(2/40),15.00%(6/40)and 27.50%(11/40).Conclusion Ultrasound-guided percutaneous transluminal angioplasty has comparative advantages of less trauma,lower incidence of adverse reactions,relief of patients'pain,and can reduce the radiation damage to patients and medical staff,and has high clinical promotion value.