Fogarty导管取栓联合高压球囊腔内成形术在老年血液透析患者自体动静脉内瘘狭窄伴血栓形成中的应用  

Application of Fogarty catheter thrombectomy combined with high-pressure balloon intraluminal angioplasty in elderly hemodialysis patients with stenosis and thrombosis in autologous arteriovenous fistula

作　　者：阮强[1] 李昭辉[1] 黄强[1] 黄智勇[1] 郭伟昌[1] RUAN Qiang;LI Zhao-Hui;HUANG Qiang;HUANG Zhi-Yong;GUO Wei-Chang(Department of Vascular Surgery, Yibin First People′s Hospital, Yibin 644000, Sichuan Province, China)

机构地区：[1]宜宾市第一人民医院血管外科,四川宜宾644000

出　　处：《中华老年多器官疾病杂志》2021年第12期903-907,共5页Chinese Journal of Multiple Organ Diseases in the Elderly

基　　金：宜宾市科技局重点项目(2016YZY001)。

摘　　要：目的探讨Fogarty导管取栓联合高压球囊腔内成形术在老年血液透析患者自体动静脉内瘘狭窄伴血栓形成中的应用。方法选择2018年3月至2019年3月于宜宾市第一人民医院杂交手术室同期行Fogarty导管取栓和高压球囊腔内成形术的老年血液透析患者42例为研究对象,分析其治疗效果、并发症、通畅率及其影响因素。采用SPSS 22.0统计软件进行数据分析。采用Breslow检验对术后内瘘通畅时间影响因素进行单因素分析,Cox风险回归分析对术后内瘘通畅率影响因素进行多因素分析。结果手术成功率为95.24%(40/42),术后并发症发生率为9.52%(4/42)。手术成功的患者术后1个月通畅率97.5%(39/40),3个月通畅率87.5%(35/40),6个月通畅率72.5%(29/40),12个月通畅率52.5%(21/40),24个月通畅率22.5%(9/40)。单因素分析结果显示:术后吸烟、血糖和血压控制差、残留狭窄、吻合口狭窄及穿刺点狭窄是影响老年患者术后内瘘通畅时间的独立危险因素(均P<0.05)。多因素Cox分析结果显示:术后吸烟、血糖和血压控制差、残留狭窄、吻合口狭窄及穿刺点狭窄是影响老年患者术后内瘘通畅率的独立危险因素(均P<0.05)。结论Fogarty导管取栓联合高压球囊腔内成形术治疗老年血液透析患者自体动静脉内瘘狭窄伴血栓形成手术成功率高,术后短中期通畅率较高,并发症较少。术后吸烟、血糖或血压控制差、残留狭窄、吻合口狭窄及穿刺点狭窄是影响老年患者术后内瘘通畅率的重要因素。Objective To explore the clinical application and clinical efficacy of Fogarty catheter thrombectomy combined with high-pressure balloon intraluminal angioplasty in elderly hemodialysis patients with stenosis and thrombosis in autologous arteriovenous fistula.Methods A total of 42 elderly hemodialysis patients who underwent thrombus removal with Fogarty catheter and high-pressure balloon angioplasty at the same time in the hybrid operating room of Yibin First People′s Hospital from March 2018 to March 2019 were recruited in this study.Their clinical outcome,complications,patency rate and its influencing factors were analyzed.SPSS statistics 22.0 was used for data analysis.Breslow test was used to analyze the factors influencing the postoperative fistula time after hybrid surgery,and Cox risk regression analysis was employed to analyze the factors influencing the patency rate of postoperative fistula.Results The success rate of operation was 95.24%(40/42),and the postoperative complication rate was 9.52%(4/42).The patency rate of the patients with successful operation was 97.5%(39/40)at 1 month,87.5%(35/40)at 3 months,72.5%(29/40)at 6 months,52.5%(21/40)at 12 months,and 22.5%(9/40)at 24 months.The results of univariate analysis showed that postoperative smoking,poor control on blood glucose and blood pressure,residual stenosis,anastomotic stenosis and puncture point stenosis were independent risk factors affecting the patency time of internal fistula in elderly patients(all P<0.05).The results of multivariate Cox analysis showed that postoperative smoking,poor control on blood glucose and blood pressure,residual stenosis,anastomotic stenosis and puncture site stenosis were independent risk factors affecting the patency rate of postoperative internal fistula in elderly patients(all P<0.05).Conclusion Fogarty catheter thrombectomy combined with high-pressure balloon endovascular angioplasty has a high success rate,high short-and mid-term postoperative patency rate and fewer postoperative complications in the treat

关 键 词：老年人 老年血液透析 自体动静脉内瘘狭窄伴血栓形成 FOGARTY导管 高压球囊 杂交手术 

分 类 号：R654.3[医药卫生—外科学]