血液透析动静脉内瘘狭窄在超声引导下球囊扩张术的观察评价
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摘要
目的:观察血液透析后患者动静脉内瘘狭窄在超声引导下进行球囊扩张术治疗的临床疗效与安全性。方法:回顾性分析我院2016年2月至2018年12月住院的31例上肢动静脉内瘘血管狭窄患者,通过超声引导下行球囊扩张术进行治疗,对治疗前、治疗后患者内瘘狭窄处内径、最大流速、内瘘通过血流量和透析血流量等进行比较,观察治疗效果和并发症发生情况。结果:患者治疗前狭窄处内径、最大流速、内瘘通过血流量和透析血流量指标分别为(1.26±0.36)mm、(483.26±37.62)cm·s~(-1)、(248.82±27.86)mL·min~(-1)、(157.64±23.78)mL·min~(-1),治疗后相应指标分别为(3.04±0.27)mm、(296.34±25.56)cm·s~(-1)、(534.32±46.29)mL·min~(-1)、(323.27±29.43)mL·min~(-1),通过球囊扩张治疗前后对比,其差异有统计学意义(P<0.05)。其中治疗后3例出现穿刺部位周围少量渗血或局部小血肿形成,其并发症发生率为9.68%(3/31)。结论:血液透析动静脉内瘘狭窄患者经超声引导下球囊扩张术治疗后,其内瘘狭窄部位可达到较好的临床治疗效果,且损伤较小,术后发生并发症低。
Objective:To study the clinical treatment effects and safety of performing balloon dilation under ultrasound guidance in patients who suffer arteriovenous fistula after hemodialysis.Methods:A retrospective analysis was made to31cases of patients suffering from internal arteriovenous fistula and angiostenosis in their upper limbs and going through treatments in our hospital from February of 2016 till December of 2018.The research compares internal diameters of internal fistula at narrow spots,maximum blood flow rates,blood flow volumes through internal fistula,and blood flow volumes during hemodialysis in patients before and after going through balloon dilation under ultrasound guidance;the research observes the treatment effects and occurrence of complications.Results:Before treatment,internal diameter of internal fistula at narrow spots,maximum blood flow rates,blood flow volumes through internal fistula,and blood flow volumes during hemodialysis in patients was(1.26±0.36)mm、(483.26±37.62)cm·s~(-1)、(248.82±27.86)m L·min~(-1)、(157.64±23.78)m L·min~(-1)respectively;after treatment,internal diameter of internal fistula at narrow spots,maximum blood flow rates,blood flow volumes through internal fistula,and blood flow volumes during hemodialysis in patients was(3.04±0.27)mm、(296.34±27.56)cm·s~(-1)、(534.32±46.29)m L·min~(-1)、(323.27±29.43)m L·min~(-1)respectively.By comparing relevant figures before and after treatments,the P value is less than 0.05,so the difference was statistically significant.After treatment,3 cases had slight bleeding or hematoma at the punctured sites and occurrence rate of complications was only 9.68%.Conclusions:The clinical treatment effects of balloon dilatation under ultrasound guidance in patients suffering from arteriovenous fistula after hemodialysis are substantial,and the occurrence of complications after treatment is scarce.
Objective:To study the clinical treatment effects and safety of performing balloon dilation under ultrasound guidance in patients who suffer arteriovenous fistula after hemodialysis.Methods:A retrospective analysis was made to31cases of patients suffering from internal arteriovenous fistula and angiostenosis in their upper limbs and going through treatments in our hospital from February of 2016 till December of 2018.The research compares internal diameters of internal fistula at narrow spots,maximum blood flow rates,blood flow volumes through internal fistula,and blood flow volumes during hemodialysis in patients before and after going through balloon dilation under ultrasound guidance;the research observes the treatment effects and occurrence of complications.Results:Before treatment,internal diameter of internal fistula at narrow spots,maximum blood flow rates,blood flow volumes through internal fistula,and blood flow volumes during hemodialysis in patients was(1.26±0.36)mm、(483.26±37.62)cm·s~(-1)、(248.82±27.86)m L·min~(-1)、(157.64±23.78)m L·min~(-1)respectively;after treatment,internal diameter of internal fistula at narrow spots,maximum blood flow rates,blood flow volumes through internal fistula,and blood flow volumes during hemodialysis in patients was(3.04±0.27)mm、(296.34±27.56)cm·s~(-1)、(534.32±46.29)m L·min~(-1)、(323.27±29.43)m L·min~(-1)respectively.By comparing relevant figures before and after treatments,the P value is less than 0.05,so the difference was statistically significant.After treatment,3 cases had slight bleeding or hematoma at the punctured sites and occurrence rate of complications was only 9.68%.Conclusions:The clinical treatment effects of balloon dilatation under ultrasound guidance in patients suffering from arteriovenous fistula after hemodialysis are substantial,and the occurrence of complications after treatment is scarce.
引文
[1]陈妙娴.维持性血液透析患者动静脉内瘘闭塞的原因分析与干预[J].中国医药指南,2015,13(3):74-75.
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[5]陈松,李晓颖,于黔,等.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[J].中国超声医学杂志,2018,34(4):342-346.
[6]彭鑫,涂波,刘杨东,等.超声引导下经皮腔内血管成形术治疗动静脉内瘘狭窄的应用价值[J].临床超声医学杂志,2016,18(8):548-550.
[7]朱宇莉,丁红,范培丽,等.彩超对维持性血透患者自体动静脉内瘘血流量及血流动力学的监测[J].中国超声医学杂志,2014,30(9):824-826.
[8]吕霞,王浩宇,刘园园,等.超声引导下经皮静脉球囊扩张术治疗动静脉内瘘狭窄的临床观察[J].广西医学,2017,39(9):1413-1415.
[2]吴春燕,应迎娟,王秀萍,等.球囊扩张治疗血液透析患者内瘘狭窄的围手术期护理[J].全科医学临床与教育,2009,7(1):79-80.
[3]陈景涛,马会镜,樊翠霞,等.血液透析患者血管通路类型选择及护理方法[J].实用临床护理学电子杂志,2018,3(19):183-184.
[4]叶有新.血液透析血管径路的建立和维护新进展[M].北京:军事医学科学出版社,2014:141-144.
[5]陈松,李晓颖,于黔,等.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[J].中国超声医学杂志,2018,34(4):342-346.
[6]彭鑫,涂波,刘杨东,等.超声引导下经皮腔内血管成形术治疗动静脉内瘘狭窄的应用价值[J].临床超声医学杂志,2016,18(8):548-550.
[7]朱宇莉,丁红,范培丽,等.彩超对维持性血透患者自体动静脉内瘘血流量及血流动力学的监测[J].中国超声医学杂志,2014,30(9):824-826.
[8]吕霞,王浩宇,刘园园,等.超声引导下经皮静脉球囊扩张术治疗动静脉内瘘狭窄的临床观察[J].广西医学,2017,39(9):1413-1415.