超声引导下球囊扩张术在尿毒症维持性血液透析患者动静脉内瘘狭窄治疗中的应用

Color Doppler ultrasound guided balloon dilation for arteriovenous fistula stenosis of patients with uremia taking maintenance hemodialysis

目的探讨彩色多普勒超声(CDFI)引导下动静脉内瘘(AVF)球囊扩张术在尿毒症维持性血液透析(MHD)患者治疗中的应用价值。方法回顾性分析,选取2020年2月至2023年2月在南阳市第一人民医院治疗的500例尿毒症MHD AVF狭窄患者作为研究对象,根据手术方法分为观察组(243例)和对照组(257例)。观察组男130例、女113例,年龄(49.53±6.23)岁,在CDFI引导下实施AVF球囊扩张术;对照组男122例、女135例,年龄(50.11±6.98)岁,行内瘘切除修复术。对比两组患者手术情况、内瘘修复情况、透析前后氧化应激指标[超氧化物歧化酶(SOD)、丙二醛(MDA)、髓过氧化物酶(MPO)]、血液循环指标(峰值流速、内瘘血流量、血管内径)、并发症及透析后6个月内瘘再狭窄情况。统计学方法采用t检验、χ^(2)检验。结果观察组手术成功率、内瘘通畅率均高于对照组[97.94%(238/243)比82.88%(213/257)、100.00%(243/243)比80.54%(207/257)],差异均有统计学意义(χ^(2)=32.060、52.529,均P<0.05)。透析前,两组患者氧化应激指标、血液循环指标比较,差异均无统计学意义(均P>0.05)。透析3个月后,观察组SOD指标及内瘘血流量、血管内径均高于对照组[(89.43±9.76)IU/ml比(84.53±9.14)IU/ml、(447.54±27.28)ml/min比(383.69±25.39)ml/min、(3.27±0.42)mm比(2.48±0.39)mm],MDA、MPO指标及峰值流速均低于对照组[(6.19±0.49)nmol/ml比(6.47±0.56)nmol/ml、(39.87±4.92)IU/L比(42.18±5.17)IU/L、(241.64±19.87)cm/s比(267.52±20.13)cm/s],差异均有统计学意义(t=5.797、27.106、21.808、5.936、5.112、14.459,均P<0.05)。观察组并发症发生率及透析后6个月内瘘再狭窄率均低于对照组[10.29%(25/243)比16.34%(42/257)、2.88%(7/243)比7.78%(20/257)],差异均有统计学意义(χ^(2)=3.945、5.874,均P<0.05)。结论CDFI引导下AVF球囊扩张术治疗尿毒症MHD患者,可提高内瘘通畅率及手术成功率,改善血液循环,减轻氧化应激反应,提高安全性,降低术后内瘘再狭窄风险。

Objective To explore the application value of color Doppler ultrasound(CDFI)guided balloon dilation of arteriovenous fistula(AVF)in the treatment of patients with uremia taking maintenance hemodialysis(MHD).Methods Five hundred patients with uremia undergoing MHD AVF stenosis at Nanyang First People's Hospital from February 2020 to February 2023 were selected as the study objects,and were divided into an observation group(243 cases)and a control group(257 cases)according the surgical methods.There were 130 males and 113 females in the observation group;they were(49.53±6.23)years old.There were 122 males and 135 females in the control group;they were(50.11±6.98)years old.The observation group underwent CDFI guided AVF balloon dilation,while the control group internal fistula resection and repair.The surgical conditions,internal fistula repair status,oxidative stress indicators[superoxide dismutase(SOD),malondialdehyde(MDA),and myeloperoxidase(MPO)]before and after the dialysis,blood circulation indicators(peak flow rate,internal fistula blood flow volume,and vascular diameter),complications,and internal fistula restenosis 6 months after the dialysis were compared between the two groups.t andχ^(2) tests were applied.Results The surgery success rate and the patency rate of internal fistula in the observation group were higher than those in the control group[97.94%(238/243)vs.82.88%(213/257)and 100.00%(243/243)vs.80.54%(207/257)],with statistical differences(χ^(2)=32.060 and 52.529;both P<0.05).Before the dialysis,there were no statistical differences in the oxidative stress indicators and blood circulation indicators between the two groups(all P>0.05).Three months after the dialysis,the SOD level,internal fistula blood flow volume,and vascular diameter in the observation group were higher than those in the control group[(89.43±9.76)IU/ml vs.(84.53±9.14)IU/ml,(447.54±27.28)ml/min vs.(383.69±25.39)ml/min,and(3.27±0.42)mm vs.(2.48±0.39)mm];the levels of MDA and MPO and peak flow rate in the observation group were lower than those in the control group[(6.19±0.49)nmol/ml vs.(6.47±0.56)nmol/ml,(39.87±4.92)IU/L vs.(42.18±5.17)IU/L,and(241.64±19.87)cm/s vs.(267.52±20.13)cm/s];there were statistical differences between the two groups(t=5.797,27.106,21.808,5.936,5.112,and 14.459;all P<0.05).The incidence of complications and the restenosis rate of internal fistula within 6 months after the dialysis in the observation group were lower than those in the control group[10.29%(25/243)vs.16.34%(42/257)and 2.88%(7/243)vs.7.78%(20/257)],with statistical differences(χ^(2)=3.945 and 5.874;both P<0.05).Conclusion CDFI guided AVF balloon dilation for uremic patients taking MHD can increase the patency rate of internal fistula and surgery success rate,improve their blood circulation,and reduce their oxidative stress response and the risk of postoperative internal fistula restenosis,and is safe.