摘要
目的:探讨自体动静脉内瘘成熟不良的影响因素及超声下经皮腔内血管成形术(percutaneous endovascular angioplasty,PTA)治疗的临床效果.方法:选取2022年8月—2023年7月在我院行自体动静脉内瘘患者124例,观察自体动静脉内瘘成熟不良发生情况,分析自体动静脉内瘘成熟不良和成熟患者临床资料差异,并给予自体动静脉内瘘成熟不良患者超声下PTA治疗,观察其治疗效果.结果:124例患者中,自体动静脉内瘘成熟不良发生32例,发生率为25.81%;自体动静脉内瘘成熟不良患者有高血压、糖尿病和心脑血管疾病比例分别为56.25%、40.63%和46.88%,明显高于自体动静脉内瘘成熟患者;自体动静脉内瘘成熟不良患者头静脉内径、束臂后头静脉内径和桡动脉内径分别为(2.79±0.43)mm、(2.49±0.56)mm和(3.37±0.61)mm,明显小于自体动静脉内瘘成熟患者,而总胆固醇(TC)为(4.82±0.91)mmol/L,明显高于自体动静脉内瘘成熟患者;Logistic回归分析显示:高血压、糖尿病、头静脉内径和桡动脉内径是自体动静脉内瘘成熟不良的影响因素,该模型预测自体动静脉内瘘成熟不良的ROC曲线下面积为0.836(95%CI:0.755～0.917),预测灵敏性和特异性分别为81.30%和76.30%;自体动静脉内瘘成熟不良患者均成功行超声下PTA治疗,术后1个月熟率为87.50%(28/32).术后1个月血流量、瘘体静脉直径及血管壁厚度分别为(803.32±52.03)mL/min、(6.15±0.90)mm和(0.73±0.18)mm,均较术前明显提高.结论:自体动静脉内瘘成熟不良受高血压、糖尿病、头静脉内径和桡动脉内径的影响,超声下PTA治疗自体动静脉内瘘成熟不良有较好的临床效果,值得临床使用.
Abstract
Objective To explore the influencing factors of poor maturation of autologous arteriovenous fistula and the clini-cal effect of percutaneous transluminal angioplasty(PTA)treatment under ultrasound.Methods 124 patients with autologous arteriovenous fistula who were planned to undergo autologous arteriovenous fistula treatment in our hospital from August 2022 to July 2023 were selected to observe the occurrence of immature autologous arteriovenous fistula and analyze the clinical data differences between mature and immature patients.Patients with immature autologous arteriovenous fistula were given ultra-sound guided PTA treatment to observe the treatment effect.Results Out of 124 patients,32 had immature autologous arterio-venous fistula,incidence rate was 25.81%.The proportion of hypertension,diabetes and cardiovascular and cerebrovascular diseases in patients with immature autogenous arteriovenous fistula was 56.25%,40.63%and 46.88%,respectively,which was significantly higher than that in patients with mature autogenous arteriovenous fistula.The diameter of the cephalic vein,the diameter of the posterior cephalic vein,and the diameter of the radial artery in patients with immature autologous arteriovenous fistula were(2.79±0.43)mm,(2.49±0.56)mm,and(3.37±0.61)mm,respectively,which were significantly smaller than those in mature autologous arteriovenous fistula patients,while the total cholesterol(TC)was(4.82±0.91)mmol/L,which was signifi-cantly higher than those in mature autologous arteriovenous fistula patients.Logistic regression analysis showed that hyperten-sion,diabetes,the diameter of cephalic vein and radial artery were the influencing factors for the immature autogenous arteriov-enous fistula,The model predicts that the area under the ROC curve for immature autologous arteriovenous fistula was 0.836(95%CI:0.755-0.917),with predictive sensitivity and specificity was 81.30%and 76.30%,respectively,Patients with immature autologous arteriovenous fistulas were successfully treated with ultrasound guided PTA,with a maturation rate of 87.50%(28/32)at 1 monthaftersurgery.The blood flow,fistula vein diameter,and vascular wall thickness at 1months after surgery were(803.32±52.03)ml/min,(6.15±0.90)mm,and(0.73±0.18)mm,respectively,which were significantly increased compared to before surgery.Conclusion The immaturity of autogenous arteriovenous fistula is affected by hypertension,diabetes,the diameter of cephalic vein and radial artery.PTA under ultrasound has a good clinical effect on the immaturity of autogenous arteriovenous fistula,which is worthy of clinical use.
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