许进雄 林建帆 彭晓枫 彭俏颖

【摘要】 目的：分析超聲引导下经皮球囊扩张术（PTA）治疗尿毒症动静脉内瘘（AVF）狭窄患者的效果。方法：选择2019年6月-2020年6月本院收治的81例尿毒症患者为研究对象，按照随机数字表法将患者分为对照组（n=40）和观察组（n=41）。对照组予以常规外科手术治疗AVF狭窄，观察组给予超声引导下PTA治疗AVF狭窄。比较两组患者手术一般情况、通畅情况、并发症发生情况。结果：观察组手术时间、住院时间均短于对照组，术中疼痛评分低于对照组，手术费用少于对照组，差异均有统计学意义（P<0.05）。术后，观察组狭窄处内径、内瘘自然流量、穿刺针血流量、透析血流量均高于对照组，差异均有统计学意义（P<0.05）。术后，观察组出血、感染、局部肿胀以及狭窄再复发发生率为12.20%，低于对照组的30.00%，差异有统计学意义（P<0.05）。结论：和常规外科手术治疗相比，PTA治疗尿毒症AVF狭窄患者可以缩短手术和住院时间，减轻疼痛，降低治疗费用，改善通畅情况，且并发症发生率更低。

【关键词】 超声引导 经皮球囊扩张术 尿毒症 动静脉内瘘狭窄

Effect Analysis of Ultrasound-guided PTA on Uremic Patients with AVF Stenosis/XU Jinxiong， LIN Jianfan， PENG Xiaofeng， PENG Qiaoying. //Medical Innovation of China， 2021， 18（33）： 0-074

[Abstract] Objective： To analyze the effect of ultrasound-guided percutaneous transluminal angioplasty （PTA） in the treatment of uremic arteriovenous fistula （AVF） stenosis. Method： A total of 81 uremia patients admitted to our hospital from June 2019 to June 2020 were selected as the research subjects， they were divided into control group （n=40） and observation group （n=41） according to random number table method. The control group was given routine surgery to treat AVF stenosis， the observation group was given ultrasound-guided PTA to treat AVF stenosis. The general surgery， patency and complications of the two groups were compared. Result： The surgery time and hospital stay in the observation group were shorter than those in the control group， the intraoperative pain score was lower than that in the control group， and the surgery cost was lower than that in the control group， the differences were statistically significant （P<0.05）. After surgery， the inner diameter of stenosis， natural flow of internal fistula， blood flow of puncture needle and dialysis in the observation group were higher than those in the control group， the differences were statistically significant （P<0.05）. The recurrence rate of bleeding， infection， local swelling and stenosis in the observation group was 12.20%， lower than 30.00% in the control group， the difference was statistically significant （P<0.05）. Conclusion： Compared with routine surgical treatment， PTA in the treatment of uremic AVF stenosis can shorten the surgery and hospital stay， reduce pain， reduce treatment cost， improve patency， and lower the incidence of complications.

[Key words] Ultrasound-guided Percutaneous transluminal angioplasty Uremia Arteriovenous fistula stenosis

First-author’s address： People’s Hospital of Shanwei， Shanwei 516600， China

doi：10.3969/j.issn.1674-4985.2021.33.018

尿毒症是肾衰竭的晚期阶段，此时肾脏无法发挥正常的功能，致使患者出现以水肿、疲乏、甚至劳力性呼吸苦难等为主的临床症状[1]。目前我国大多数尿毒症患者均需通过血液透析来延长生命。动静脉内瘘（AVF）因具有安全、血流量充分、感染机会少、不影响日常生活以及易于穿刺等优点已成为维持性血液透析患者常用的血管通路[2-3]。但在临床工作中因长时间透析、穿刺以及血管自身条件等原因常导致AVF出现狭窄，导致内瘘失功，影响引流，进而降低透析效果。……