尿毒症血液透析患者动静脉内瘘狭窄超声引导下PTA术后的疗效观察  

The Effect of Arteriovenous Fistula Stenosis in Dialysis Patients Treated with PTA Conducted By Ultrasound

作　　者：陈松[1] 李晓颖[1] 于黔[1] 吴欣[1] 闵亚丽[1] 邓超[1] 张庆华[1] Chen Song;Li Xiaoying;Yu Qian;Wu Xin;Min Yali;Deng Chao;Zhang Qinghua(Department of Nephrology, the First People＇s Hospital, Guiyang, Guizhou 550002, Chin)

机构地区：[1]贵阳市第一人民医院肾内科,贵阳市550002

出　　处：《中国超声医学杂志》2018年第4期342-346,共5页Chinese Journal of Ultrasound in Medicine

摘　　要：目的了解超声引导下动静脉内瘘狭窄PTA手术的疗效及影响因素。方法收集于我院就诊的尿毒症血液透析患者动静脉内瘘狭窄在超声引导下行PTA手术的患者40例,作为手术组;同时选取在我院规律血液透析的内瘘成熟并正常使用的患者20例,作为对照组,对照组与手术组在性别、年龄、钙磷指标、原发病、血压方面无统计学差异(P>0.05)。测量对照组与手术组术前、术后、术后1、3个月、半年、1年内瘘血管的血管内径,内瘘自然血流量、穿刺针血流量指标,观察手术组上述各监测时间点的内瘘通畅率。并分析患者PTA术后内瘘通畅率与其临床指标的相关性,进一步分析超声引导下PTA的手术效果及其影响术后通畅率的因素。结果超声引导下内瘘血管狭窄球囊扩张的成功率为92.5%,术后1、3、6、12个月的通畅率分别为94.6%、91.9%、73.0%、48.6%。患者PTA手术后血管内径、血管内自然血流量、穿刺针血流量较术前均有明显增加(P<0.05);PTA术后内瘘血管内径与对照组相比,术后6个月及术后12个月内径有明显缩小(P<0.05);PTA术后12个月血管内自然血流量较对照组明显减少(P<0.05),手术组术后各时间点透析穿刺针血流量相较于对照组,并无明显差异。PTA术后内瘘通畅情况和原发病明显相关,糖尿病患者术后内瘘使用时间明显缩短,有统计学差异(P<0.05)。结论超声引导下PTA手术可有效治疗动静脉内瘘狭窄,其手术创伤小,可为尿毒症血液透析患者节约宝贵的血管资源,值得在临床上进一步推广。Objective To observe the effect of arteriovenous fistula stenosis in dialysis patients treated with PTA conducted by ultrasound and the influence factors. Methods Collected 40 cases whose arteriovenous fistula stenosis in dialysis treated with PTA conducted by ultrasound from as operation group, meanwhile collected 20 cases whose arteri ovenous fistula used commonly in hemodialysis in as control group. There is no difference between the two groups in sex,age,calcium phosphrous index, primary disease, blood pressure. Measured the internal diameter, vascular natural blood flow and puncture needle blood flow in the control group and the operation group of preoperative and postopera- tive, 1 st month, 3 rd month, 6 th month, 12 th month after operation. Observed the pateney rate of arteriovenous fistula in the operation group at the observed time points, and then analyzed the relationship between the patency rate of arte- riovenous fistula and the above indexes in patients after PTA. So we could observe the effect of arteriovenous fistula stenosis in dialysis patients treated with PTA conducted by ultrasound and the influence factors. Results The results showed that the success rate of arteriovenous fistula stenosis treated with PTA conducted by B ultrasound was 92.5% ,the patency rate in the 1 st,3 rd,6 th,12 th month is 94.6%, 91.9%, 73.0%, 48.6%. There was a signifi cant increase after PTA operation, the internal diameter, vascular natural blood flow and puncture needle blood flow than those of before（P〈0.05）. Compared with controlled group, the internal diameter in the 6 th month and 12 th month after operation significantly reduced（P〈0.05）, the vascular natural blood flow in the 12 th month after opera lion notablely declined（P〈0.05）, but there is no remarkably reduction of puncture needle blood flow. The utility time of fistula after PTA operation is related with primary disease, the primary disease of diabetic has the shorter utility time, there is a significant difference（P〈0.05）. Conc

关 键 词：动静脉内瘘狭窄 超声引导 PTA 术 

分 类 号：R445.1[医药卫生—影像医学与核医学] R692.5[医药卫生—诊断学]