超声引导下经皮球囊扩张术在维持性血液透析患者动静脉内瘘狭窄中的应用效果研究

Application of Ultrasound-guided Percutaneous Balloon Dilation in Patients with Stenosis of Arteriovenous Fistula in Maintenance Hemodialysis

目的:分析维持性血液透析患者在动静脉内瘘(AVF)狭窄治疗中采用超声引导经皮球囊扩张术的效果。方法:选取2020年9月—2021年9月长江大学附属第一人民医院进行血液透析且发生AVF狭窄的患者78例为研究对象,依据手术中引导方式不同将患者分为常规组(n=38)和超声组(n=40)。常规组采用数字减影血管造影(DSA)引导实施经皮球囊扩张术,超声组采用超声引导实施经皮球囊扩张术。比较两组患者手术相关指标以及血液透析指标变化情况,并统计患者术后并发症发生率。结果:与参照组比较,超声组患者一次性穿刺成功率和手术成功率均升高,6个月内内瘘狭窄率降低,差异有统计学意义(P<0.05)。与术前比较,术后1d两组患者血管内径增大,肱动脉血流量、透析血流量明显升高(P<0.05),且与参照组比较,超声组患者血管内径增大,肱动脉血流量、透析血流量明显升高,差异有统计学意义(P<0.05)。与参照组比较,超声组患者术后并发症发生率明显降低,差异有统计学意义(P=0.034)。结论:超声引导经皮球囊扩张术可以提升维持性血液透析患者在AVF狭窄治疗中的手术成功率,降低内瘘再狭窄,促进血液透析的正常进行,且安全性较高。

Objective:To analyze the effect of ultrasound-guided percutaneous balloon dilatation in maintenance hemodialysis patients with arteriovenous fistula(AVF)stenosis.Methods:A total of seventy-eight patients with AVF stenosis undergoing hemodialysis in the First People's Hospital Affiliated to Yangtze University from September 2020 to September 2021 were selected as the study objects,and the patients were divided into conventional group(n=38)and ultrasound group(n=40)according to different guidance methods during surgery.The conventional group underwent percutaneous balloon dilatation guided by digital subtraction angiography(DSA),and the ultrasound group underwent percutaneous balloon dilatation guided by ultrasound.The changes of operation-related indexes and hemodialysis indexes were compared between the two groups,and the incidence of postoperative complications was calculated.Results:Compared with the conventional group,the one-time puncture success rate and surgical success rate in the ultrasound group were both increased,and the fistula stenosis rate was decreased within 6 months,the difference was statistically significant(P<0.05);compared with the preoperative results,the internal diameter of blood vessels increased,and brachial artery blood flow and dialysis blood flow increased significantly(P<0.05);compared with the conventional group,the internal diameter of blood vessels in the ultrasound group was increased,and the brachial artery blood flow and dialysis blood flow were significantly increased,the difference was statistically significant(P<0.05);compared with the conventional group,the incidence of postoperative complications in the ultrasound group was significantly reduced,and the difference was statistically significant(P=0.034).Conclusion:Ultrasound-guided percutaneous balloon dilatation can improve the success rate of surgery in maintenance hemodialysis patients with AVF stenosis,reduce the restenosis of internal fistula,and promote the normal progress of hemodialysis with high safety.