经皮腔内血管成形术在糖尿病肾病血液透析患者动静脉内瘘狭窄中的应用  

Application of percutaneous transluminal angioplasty in the treatment of arteriovenous fistula stenosis or occlusion in diabetic nephropathy patients with hemodialysis

作　　者：解德琼[1] 朱军[2] 唐前容 朱磊[1] 李程[1] 赵平[1] 

机构地区：[1]四川省宜宾市第二人民医院肾内科,四川宜宾644000 [2]四川省宜宾市第二人民医院放射介入科,四川宜宾644000

出　　处：《实用医院临床杂志》2015年第4期49-52,共4页Practical Journal of Clinical Medicine

基　　金：四川省卫生厅科研基金资助项目(编号:130501)

摘　　要：目的观察经皮腔内血管成形术(percutaneous transluminal angioplasty,PTA)在糖尿病肾病血液透析患者动静脉内瘘狭窄中的应用效果。方法选择20例基础疾病为糖尿病肾病的血液透析动静脉内瘘狭窄患者进行PTA治疗,比较PTA治疗前后的血管造影表现、透析血流量及静脉压变化。结果 19例患者经球囊扩张后,狭窄段明显扩张,触诊感血管震颤增强,经造影证实狭窄小于30%。术后首次血液透析血流量由扩张前(124.32±18.43)ml/min增至(242.12±16.35)ml/min;在血流量为250 ml/min时,静脉压由扩张前的(178.46±13.4)mm Hg降至(98.62±14.36)mm Hg;kt/V较前明显提高,差异有统计学意义(P<0.05)。术中未出现血管破裂、出血及血栓形成等并发症。结论 PTA是治疗糖尿病肾病血液透析患者动静脉内瘘狭窄的有效方法,其操作简便、创伤小、近期效果明显,对血液透析动静脉内瘘的维护有重要价值.Objective To observe the clinical effect of percutaneous transluminal angioplasty（PTA） in the treatment of arteriovenous fistula stenosis in diabetic nephropathy（DN） patients with hemodialysis.Methods Twenty hemodialytic DN patients with arteriovenous fistula stenosis were selected to have PTA.The angiographic findings,changes in blood flow volume and venous pressure level during hemodialysis between pre-and post-operation were compared.Results In 19 patients,the stenotic segment was dilated,the occluded site was re-canalized and the palpation feeling of thrill became stronger immediately after PTA.The stenosis was less than30% confirmed by angiography.The hemodialysis blood flow was increased from（124.32 ± 18.43） ml/min of pre-operation to（242.12± 16.35） ml/min of post-operation.The venous pressure was decreased from（178.46 ± 13.4） mm Hg of pre-operation to（98.62 ±14.36） mm Hg of post-operation when blood flow volume was 250 ml/min.No complications such as vascular perforation,hemorrhage and thrombosis were observed during the operation.Conclusion PTA is an effective,safe and micro-invasive treatment for arteriovenous fistula stenosis or occlusion.It could be chosen as the treatment for certain patients with indications.

关 键 词：血液透析 动静脉内瘘 经皮血管成形术 

分 类 号：R459.5[医药卫生—治疗学]