经皮腔内血管成形术在糖尿病肾病血液透析患者动静脉内瘘狭窄中的应用

摘要

目的：观察经皮腔内血管成形术（percutaneous transluminal angioplasty ，PTA）在糖尿病肾病血液透析患者动静脉内瘘狭窄中的应用效果。方法选择20例基础疾病为糖尿病肾病的血液透析动静脉内瘘狭窄患者进行 PTA 治疗，比较 PTA治疗前后的血管造影表现、透析血流量及静脉压变化。结果19例患者经球囊扩张后，狭窄段明显扩张，触诊感血管震颤增强，经造影证实狭窄小于30％。术后首次血液透析血流量由扩张前（124．32±18．43）ml／min 增至（242．12±16．35）ml／min；在血流量为250 ml／min 时，静脉压由扩张前的（178．46±13．4）mmHg 降至（98．62±14．36）mmHg；kt／V 较前明显提高，差异有统计学意义（P ＜0．05）。术中未出现血管破裂、出血及血栓形成等并发症。结论 PTA 是治疗糖尿病肾病血液透析患者动静脉内瘘狭窄的有效方法，其操作简便、创伤小、近期效果明显，对血液透析动静脉内瘘的维护有重要价值．%Objective To observe the clinical effect of percutaneous transluminal angioplasty (PTA) in the treatment of arte-riovenous fistula stenosis in diabetic nephropathy (DN) patients with hemodialysis.Methods Twenty hemodialytic DN patients with arteriovenous fistula stenosis were selected to have PTA .The angiographic findings,changes in blood flow volume and venous pressure level during hemodialysis between pre -and post-operation were compared.Results In 19 patients,the stenotic segment was dilated,the occluded site was re-canalized and the palpation feeling of thrill became stronger immediately after PTA .The stenosis was less than 30% confirmed by angiography.The hemodialysis blood flow was increased from (124.32 ±18.43)ml/min of pre-operation to(242.12 ±16.35)ml/min of post-operation.The venous pressure was decreased from (178.46 ±13.4 ) mmHg of pre-operation to (98.62 ± 14.36)mmHg of post-operation when blood flow volume was 250 ml/min.No complications such as vascular perforation ,hemorrhage and thrombosis were observed during the operation .Conclusion PTA is an effective,safe and micro-invasive treatment for arteriove-nous fistula stenosis or occlusion .It could be chosen as the treatment for certain patients with indications .