中国血液净化

中国血液净化 ›› 2022, Vol. 21 ›› Issue (08): 608-612.doi: 10.3969/j.issn.1671-4091.2022.08.016

• 血管通路 • 上一篇    下一篇

介入治疗血液透析患者中心静脉病变的疗效观察

熊良伟   崔天蕾   

  1. 610044 成都，1四川大学华西医院肾病内科
    642350 资阳，2安岳县人民医院肾病内科
  • 收稿日期:2022-01-20 修回日期:2022-05-22 出版日期:2022-08-12 发布日期:2022-08-12
  • 通讯作者: 崔天蕾 E-mail:tianleicui@163.com

The efficacy of intervention therapy for central venous lesions in hemodialysis patients 

XIONG Liang-wei,   CUI Tian-lei   

  1. Nephrology Department, West China Hospital, Sichuan University, Chengdu 610044, China;  2Nephrology Department, Anyue county People's Hospital, Ziyang 642350, China
  • Received:2022-01-20 Revised:2022-05-22 Online:2022-08-12 Published:2022-08-12
  • Contact: CUI Tian-lei E-mail:tianleicui@163.com

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摘要： 目的 观察介入治疗维持性血液透析患者中心静脉狭窄或闭塞的疗效，探索其再通后复发的危险因素。 方法 纳入2015年6月～2020年3月在四川大学华西医院肾内科住院的中心静脉狭窄或闭塞患者94例，根据其首次再通后18个月初级通畅率结局分组，分为未复发组(n=33)和复发组(n=61)，平均随访时间为(32.53±11.07)月。报道介入治疗中心静脉闭塞的技术成功率、中心静脉再通后的初级和次级通畅率，采用COX分析中心静脉再通后复发的危险因素。 结果  ①介入治疗中心静脉闭塞的技术成功率为96.23%。②中心静脉再通后的6、12、18、24个月初级和次级通畅率分别为91.50%、58.50%、30.90%、10.60%和98.80%、93.80%、92.50%、88.80%。③COX分析示：中心静脉病变部位的原始直径较小(OR=0.81，95% CI:0.69～0.94，P=0.006)，病变长度越长(0R=1.06，95% CI:1.03～1.08，P＜0.001)，未置入支架(OR=0.32，95% CI:0.21～0.50，P＜0.001)和血清钙浓度较高(OR=4.35，95% CI:1.34～14.13，   P=0.014)是中心静脉再通复发的危险因素。④秩和检验示：支架组(n=60)比无支架组(n=34)的中心静脉病变长度更长(Z=-2.037,P=0.042)。 结论 介入治疗中心静脉闭塞的技术成功率高，风险可控。多次介入治疗可提高中心静脉再通的次级通畅率。中心静脉病变部位的原始血管直径小、病变长、血钙较高，其再通后复发风险越高。开通较长的中心静脉病变后置入支架可提高其初级通畅率。

关键词: 中心静脉, 狭窄, 经皮腔内血管成形术, 透析

Abstract: Objective  To observe the efficacy of intervention for central venous stenosis (CVS) or central venous occlusion(CVO) in maintenance hemodialysis (MHD) patients, and to explore the risk factors for relapse after central venous (CV) recanalization.  Method  A total of 94 cases with CVS or CVO admitted to West China Hospital, Sichuan University between June 2015 and March 2020 were retrospectively studied. They were divided into non-relapse group (n=33) and relapse group(n=61) based on the primary patency in the 18 months after CV recanalization. The average follow-up period was 32.53±11.07 months. The technical success rate of CVO recanalization after CV intervention therapy, and the primary patency rate and secondary patency rate after CV recanalization were evaluated. Cox regression was used to analyze the risk factors for relapse after CV recanalization.  Results  ①Technical success rate of CVO recanalization after CV intervention therapy was 96.23%; ②After CV recanalization for 6, 12, 18 and 24 month, the primary patency rates were 91.50%, 58.50%, 30.90% and 10.60% respectively, and the secondary patency rates were 98.80%, 93.80%, 92.50% and 88.80% respectively; ③Cox regression showed that smaller original vascular diameter at the abnormal CV site (HR=0.81, 95% CI: 0.69～0.94, P=0.006), longer CV lesion (HR=1.06, 95% CI: 1.03～1.08, P<0.001), no stent inserted (HR=0.32, 95% CI: 0.21～0.50, P<0.001), and higher serum calcium (HR=4.35, 95% CI: 1.34～14.13, P=0.014) were the risk factors for relapse after CV recanalization; ④Rank-sum test revealed that the length of CV lesions was longer in stent group(n=60) than in non-stent group (n=34)             (Z= -2.037, P=0.042).  Conclusions  Technical success rate of CVO recanalization after CV intervention therapy was high with controllable risks. Multiple intervention therapies can improve the secondary patency rate of CV recanalization. The smaller original diameter at the CV lesion site, longer CV lesion, and higher serum calcium were the risk factors for relapse after CV recanalization. Stent placement after recanalization of longer CV lesion can improve the primary patency rate.

Key words: Central vein, Stenosis, Percutaneous angioplasty, Dialysis

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