超声引导下动静脉内瘘球囊扩张术疗效及通畅率影响因素分析

摘要 目的：观察超声引导下动静脉内瘘球囊扩张术疗效及通畅率的影响因素。方法：选择2018年6月-2020年12月在安徽医科大学第二附属医院行超声引导下自体动静脉内瘘球囊扩张患者230例作为研究对象，根据患者术前血镁水平将患者为低镁血症组87例、正常及高镁血症组143例。分析患者一般人口学资料、术前实验室检查及超声记录指标，随访预后疗效。结果：手术技术成功率98.12 %，平均随访443±100天。两组术后3个月的血管内径与透析血流量高于术前，正常及高镁血症组高于低镁血症组（P<0.05）。术后3个月正常及高镁血症组的总有效率高于低镁血症组（P<0.05）。正常及高镁血症组术后3个月、6个月与1年的血管通畅率分别为90.9 %、77.62 %、67.83 %，明显高于低镁血症组的80.46 %、64.37 %、51.72 %（P<0.05）。COX多因素分析影响随访血管1年通畅率的因素主要为镁、血管内径、肱动脉血流量、年龄等（P<0.05）。结论：超声引导下动静脉内瘘球囊扩张术对自体动静脉内瘘狭窄或血栓具有很好的效果，低镁血症、血管内径、肱动脉血流量是影响血管通畅率的重要因素。

Analysis on the Effect and Patency Rate of Ultrasonic-guided Balloon Dilatation of Arteriovenous Fistula

ABSTRACT Objective: To observe the effect of ultrasound guided balloon dilatation of arteriovenous fistula and the influencing factors of patency rate. Methods: A total of 230 patients with autologous arteriovenous fistula balloon dilation under ultrasound guidance in the Second Affiliated Hospital of Anhui Medical University from June 2018 to December 2020 were selected as the research subjects. According to the preoperative blood magnesium level of the patients, the patients were divided into the hypomagneemia group (87 cases) and the normal and hypermagnesemia group (143 cases). The patient''s general demographic data, preoperative laboratory examination and ultrasound records were analyzed, and the prognosis and efficacy were followed up. Results: The success rate was 98.12 %. The mean follow-up was 443±100 days. The vascular diameter and dialysis blood flow in the two groups at 3 months after operation were higher than those at 1 day before operation, and the normal and hypermagnesemia groups were higher than those in the hypomagnesemia group(P<0.05). The total effective rate in the normal and hypermagnesemia groups at 3 months after operation, which was higher than the hypomagnesemia group(P<0.05). All patients were followed up for 1 year after operation. The vascular patency rates of normal and hypermagnesemia groups at 3 months, 6 months, and 1 year after operation were 90.9 %, 77.62 %, 67.83 %, respectively, which were higher than those of hypomagnesemia. 80.46 %, 64.37 %, 51.72 % of the blood group(P<0.05). COX multivariate analysis showed that the main factors influencing vascular patency were magnesium, vascular diameter, blood flow of brachial artery and age (P<0.05). Conclusion: Ultrasound-guided balloon dilation of arteriovenous fistula has a good effect on stenosis or thrombosis of autologous arteriovenous fistula. Hypomagneemia, vascular diameter and brachial artery blood flow are important factors affecting vascular patency rate.