超声引导下球囊扩张在透析患者内瘘血管狭窄中的应用  

Application of Ultrasound-Guided Percutaneous Transluminal Angioplasty in the Treatment of Internal Fistula Stenosis in Dialysis Patients

作　　者：李家燕 王岩 蔡礼华 曾言 LI Jiayan;WANG Yan;CAI Lihua;ZENG Yan(Department of Ultrasound,Luoyang East People’s Hospital/the Third Affiliated Hospital of Henan University of Science and Technology,Luoyang 471003,China;Department of Hemodialysis,Luoyang East People’s Hospital/the Third Affiliated Hospital of Henan University of Science and Technology,Luoyang 471003,China)

机构地区：[1]洛阳市东方人民医院/河南科技大学第三附属医院超声医学科,河南洛阳471003 [2]洛阳市东方人民医院/河南科技大学第三附属医院血液透析科,河南洛阳471003

出　　处：《河南医学研究》2024年第18期3278-3281,共4页Henan Medical Research

摘　　要：目的探讨超声引导下经皮球囊扩张术(PTA)在透析患者内瘘血管狭窄中的应用。方法选取洛阳市东方人民医院2020年1月至2023年1月收治的86例透析伴有内瘘血管狭窄患者,均行PTA治疗,分为研究组[43例,彩色多普勒超声(CDFI)引导下]和对照组[43例,数字减影血管造影(DSA)引导下]。比较两组的一次性穿刺成功率、手术成功率、超声相关参数测定、内瘘通畅和再狭窄发生率及并发症。结果与对照组的一次性穿刺成功率83.72%比较,研究组的100.00%更高(P<0.05);对照组手术成功率为90.70%,研究组为97.67%,差异无统计学意义(P>0.05)。与术前比较,两组术后透析血流量、血管内径升高,术后透析峰值流速降低(P<0.05),与对照组比较,研究组透析血流量、血管内径更高,透析峰值流速更低(P<0.05)。与对照组术后3、6、12个月的内瘘通畅率比较,研究组更高(P<0.05),与对照组术后3、6、12个月的内瘘再狭窄率比较,研究组更低(P<0.05)。与对照组的并发症发生率(23.26%)比较,研究组(4.65%)更低(P<0.05)。结论在超声引导下PTA治疗透析伴有内瘘血管狭窄患者,可有效提高一次性穿刺成功率和内瘘通畅率,增宽管腔狭窄处内径,增大透析血流量,降低内瘘再狭窄率和并发症发生率。Objective To explore the application of ultrasound-guided percutaneous transluminal angioplasty(PTA)in the treatment of internal fistula stenosis in dialysis patients.Methods A total of 86 patients with dialysis and internal fistula vascular stenosis admitted to Luoyang Eastern People’s Hospital from January 2020 to January 2023 were selected,and all patients underwent PTA treatment.They were divided into study group[43 cases,guided by color Doppler ultrasound(CDFI)]and control group[43 cases,guided by digital subtraction angiography(DSA)].The one-time puncture success rate,surgical success rate,ultrasound related parameters,fistula patency and restenosis rate and complications were compared between the two groups.Results Compared with the control group(83.72%),the success rate of one-time puncture in the study group(100.00%)was higher(P<0.05).The success rate of operation was 90.70%in the control group and 97.67%in the study group,and the difference was not statistically significant(P>0.05).Compared with before operation,the blood flow and vascular diameter of the two groups were increased,and the peak flow rate of dialysis was decreased after operation(P<0.05).Compared with the control group,the blood flow and vascular diameter of dialysis in the study group were higher,and the peak flow rate of dialysis was lower(P<0.05).Compared with the control group,the patency rate of internal fistula in the study group was higher,and the restenosis rate of internal fistula in the study group was lower at 3,6 and 12 months after operation(P<0.05).Compared with the control group(23.26%),the incidence of complications in the study group(4.65%)was lower(P<0.05).Conclusion Ultrasound-guided PTA in the treatment of hemodialysis patients with internal fistula stenosis can effectively improve the success rate of one-time puncture and the patency rate of internal fistula,widen the diameter of the stenosis,increase the blood flow of dialysis,and reduce the restenosis rate of internal fistula and the incidence of complications.

关 键 词：超声 经皮球囊扩张术 透析 内瘘血管狭窄 

分 类 号：R692.5[医药卫生—泌尿科学]