动静脉内瘘重建术和经皮球囊扩张术治疗自体动静脉内瘘狭窄效果及术后内瘘低血流量影响因素分析  

Effect of Arteriovenous Fistula Reconstruction and Percutaneous Balloon Dilatation in the Treatment of Autologous Arteriovenous Fistula Stenosis and Analysis of the Influencing Factors of Low Blood Flow of Internal Fis⁃tula after Operation

作　　者：陈芽 魏嵬[1] 李冰城 万茂林[1] 张波[1] 李春林 刘四斌[1] 竺瑾怡 苏子良 吴文泽[1] CHEN Ya;WEI Wei;LI Bingcheng;WAN Maolin;ZHANG Bo;LI Chunlin;LIU Sibin;ZHU Jinyi;SU Ziliang;WU Wenze(Department of Radiology,Jingzhou Central Hospital Jingzhou Hospital Affiliated to Yangtze University,Jingzhou,Hubei 434020,China;Department of Ultrasound,Jingzhou Central Hospital Jingzhou Hospital Affiliated to Yangtze University,Jingzhou,Hubei 434020,China)

机构地区：[1]荆州市中心医院(长江大学附属荆州医院)放射科,湖北荆州434020 [2]荆州市中心医院(长江大学附属荆州医院)超声科,湖北荆州434020

出　　处：《临床误诊误治》2025年第7期50-54,共5页Clinical Misdiagnosis & Mistherapy

基　　金：湖北省自然科学基金项目(2024AFC023)。

摘　　要：目的分析动静脉内瘘重建术和经皮球囊扩张术治疗自体动静脉内瘘(AVF)狭窄的效果及术后内瘘低血流量的影响因素。方法选取2020年1月至2023年1月接受治疗的AVF狭窄患者251例,根据治疗方法分为对照组121例和观察组130例。对照组行动静脉内瘘重建术治疗,观察组行经皮球囊扩张术治疗。比较2组临床疗效及术后并发症发生情况。根据患者术后内瘘血流量情况进行分组,其中22例纳入低血流量组,229例纳入正常血流量组,采用多因素logistic回归分析AVF狭窄患者术后内瘘低血流量的影响因素。结果术后1个月,观察组有效率91.54%(119/130)高于对照组80.99%(98/121,P<0.05)。2组术后并发症发生情况比较无统计学差异(P>0.05)。2组术后3、6、12个月的内瘘通畅率和术后内瘘低血流量发生率比较均无明显差异(P>0.05)。经多因素lo⁃gistic回归分析发现,内瘘使用时间与合并糖尿病为AVF狭窄患者术后内瘘低血流量的独立危险因素(P<0.05,P<0.01)。结论经皮球囊扩张术治疗AVF狭窄的效果较好,对改善患者预后、提高生活质量有重要意义。内瘘使用时间和合并糖尿病是AVF狭窄患者术后内瘘低血流量的危险因素,应注意患者内瘘使用时间以及是否合并糖尿病,以便于术前充分准备,提高手术成功率。Objective To analyze the effect of arteriovenous fistula reconstruction and percutaneous balloon dilatation in the treatment of autologous arteriovenous fistula(AVF)stenosis and the influencing factors of low blood flow of the fistula after operation.Methods A total of 251 patients with AVF stenosis who were treated from January 2020 to January 2023 were selected and divided into the control group(n=121)and the observation group(n=130)according to the treatment meth⁃ods.The control group was treated with arteriovenous fistula reconstruction,and the observation group was treated with percu⁃taneous balloon dilatation.The clinical efficacy and postoperative complications were compared between the two groups.Ac⁃cording to the postoperative fistula blood flow of patients,they were divided into low blood flow group(n=22)and normal blood flow group(n=229).Multivariate logistic regression was used to analyze the influencing factors of low blood flow in pa⁃tients with AVF stenosis after operation.Results At 1 month after operation,the effective rate of the observation group was 91.54%(119/130),which was higher than 80.99%(98/121)of the control group(P<0.05).There was no significant difference in the incidence of postoperative complications between the two groups(P>0.05),nor in the patency rate of inter⁃nal fistula and the incidence of low blood flow of internal fistula at 3,6 and 12 months after operation between the two groups(P>0.05).Multivariate logistic regression analysis showed that the duration of fistula use and diabetes mellitus were inde⁃pendent risk factors for low blood flow in patients with AVF stenosis after operation(P<0.05,P<0.01).Conclusion Per⁃cutaneous balloon dilatation is effective in the treatment of AVF stenosis,which is of great significance for improving the prog⁃nosis and quality of life of patients.The duration of fistula and diabetes mellitus are the risk factors of low blood flow of fistula in patients with AVF stenosis after operation.Therefore,attention should be paid to the

关 键 词：血液透析 球囊扩张术 动静脉内瘘狭窄 低血流量 疗效 并发症 糖尿病 危险因素 

分 类 号：R692.5[医药卫生—泌尿科学]