超声介入治疗自体动静脉内瘘狭窄的效果评估与分析

Evaluation and analysis of the effect of ultrasound intervention in the treatment of autologous arteriovenous fistula stenosis

目的研究超声引导下经皮腔内血管成形术(PTA)治疗自体动静脉内瘘(AVF)狭窄的临床效果。方法选取2020年9月至2023年9月赣州市人民医院收治的68例自体AVF狭窄患者作为研究对象,根据随机数字表法分为对照组(n=34)和观察组(n=34)。对照组予以数字减影血管造影(DSA)引导下PTA治疗,观察组采用超声引导下PTA治疗,比较两组的临床手术指标,比较两组治疗前后的AVF狭窄处超声测量指标[血管内径、横断面积、收缩期峰值流速(PSV)、自然血流量],比较两组治疗前后的炎症因子[超敏C反应蛋白(hs-CRP)、白细胞介素-6(IL-6)]水平,并比较两组的并发症发生率。结果观察组的手术时间、住院时间均短于对照组,内瘘通畅率高于对照组,差异有统计学意义(P<0.05)。治疗后,两组患者的血管内径、横断面积及自然血流量均大于本组治疗前,PSV慢于本组治疗前,差异有统计学意义(P<0.05);且观察组治疗后的血管内径、横断面积及自然血流量大于对照组,PSV慢于对照组,差异有统计学意义(P<0.05)。治疗后,两组患者的hs-CRP及IL-6水平均低于本组治疗前,且观察组的hs-CRP及IL-6水平均低于对照组,差异有统计学意义(P<0.05)。观察组的并发症总发生率低于对照组,差异有统计学意义(P<0.05)。结论超声引导下PTA是自体AVF狭窄的首选治疗方式,可以术中直接评估疗效,更好地改善内瘘通畅率及自然血流量,调节炎症因子,降低并发症风险,还可以避免对比剂和射线伤害,较DSA引导下PTA疗效更佳,值得推广。

Objective To investigate the clinical effect of ultrasound-guided percutaneous transluminal angioplasty(PTA)in the treatment of stenosis of autologous arteriovenous fistula(AVF).Methods Sixty-eight patients with autologous AVF stenosis admitted to Ganzhou People's Hospital from September 2020 to September 2023 were selected as the study objects,and they were divided into control group(n=34)and observation group(n=34)according to random number table method.The control group was treated with PTA under the guidance of digital subtraction angiography(DSA),and the observation group was treated with ultrasound-guided PTA.The clinical surgical indexes of the two groups were compared,and the ultrasonic measurement indexes of AVF stenosis(internal vascular diameter,cross-sectional area,peak systolic velocity[PSV],natural blood flow)were compared between the two groups before and after treatment.The changes of inflammatory factors(hypersensitive C-reactive protein[hs-CRP]and interleukin-6[IL-6])before and after treatment were compared between the two groups,and the incidence of complications was compared between the two groups.Results The operation time and hospital stay in the observation group were shorter than those in the control group,the patency rate of internal fistula in the observation group was higher than that in the control group,and the differences were statistically significant(P<0.05).After treatment,the internal vascular diameter,cross-sectional area and natural blood flow in the two groups were bigger than those before the treatment,and the PSV of the two groups were slower than those before the treatment,with statistically significant differences(P<0.05).And the in ternal vascular diameter,cross-sectional area and natural blood flow after treatment in the observation group were bigger than those in the control group,and the PSV in the observation group was slower than that in the control group,with statistically significant differences(P<0.05).After treatment,the levels of hs-CRP and IL-6 in th two groups were lower than those before treatment,and the levels of hs-CRP and IL-6 in the observation group were lower than those in the control group,and the differences were statistically significant(P<0.05).The total incidence of complications in the observation group was lower than that in the control group,and the difference was statistically significant(P<0.05).Conclusion Ultrasound guided PTA is the preferred treatment for autologous AVF stenosis,which can directly evaluate the efficacy during surgery,improve the patency rate and natural blood flow of the fistula,regulate inflammatory factors,reduce the risk of complications,and avoid contrast agent and radiation damage.Compared with DSA guided PTA,it has better therapeutic effects and is worth promoting.