中国血液净化

中国血液净化 ›› 2023, Vol. 22 ›› Issue (09): 668-671.doi: 10.3969/j.issn.1671-4091.2023.09.007

• 临床研究 • 上一篇    下一篇

血管内超声在维持性血液透析患者中心静脉疾病诊断与治疗中的应用价值

周 亚   东辛欣   朱桂珍   闫国胜   马 旭   张宏涛   

  1. 450003 郑州，1郑州大学人民医院 河南省人民医院肾内科 河南省肾脏病免疫重点实验室 河南省肾病临床医学研究中心
  • 收稿日期:2023-04-04 修回日期:2023-07-04 出版日期:2023-09-12 发布日期:2023-09-12
  • 通讯作者: 张宏涛 E-mail:zhtzzu@126.com
  • 基金资助:
    河南省重点研发专项项目(221111310800)

The value of intravascular ultrasonography in the diagnosis and treatment of central venous diseases in maintenance hemodialysis patients

ZHOU Ya, DONG Xin-xin, ZHU Gui-zhen, YAN Guo-sheng, MA Xu, ZHANG Hong-tao   

  1. Department of Nephrology, People’s Hospital of Zhengzhou University, Henan Provincial People’s Hospital, Henan Key Laboratory of Kidney Disease and Immunology, Henan Provincial Clinical Research Center for Kidney Disease, Zhengzhou 450003, China
  • Received:2023-04-04 Revised:2023-07-04 Online:2023-09-12 Published:2023-09-12
  • Contact: 450003 郑州，1郑州大学人民医院 河南省人民医院肾内科 河南省肾脏病免疫重点实验室河南省肾病临床医学研究中心 E-mail:zhtzzu@126.com

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摘要： 目的  探讨血管内超声(intravascular ultrasound，IVUS)在维持性血液透析(maintenance hemodialysis,MHD)患者中心静脉疾病(central venous disease，CVD)诊断与治疗中的应用价值。 方法  选取河南省人民医院肾内科2020年2月1日—2021年3月1日5例MHD合并CVD患者，进行数字减影血管造影(digital subtraction angiography，DSA)与血管内超声(intravascular ultrasound，IVUS)成像，记录患者CVD病变部位及程度。 结果 5例CVD患者中2例患者中心静脉存在轻度狭窄，3例存在闭塞病变。DSA检出6处病变，其中3处血栓形成；IVUS检测出8处病变，4处为血栓形成，2处为主动脉压迫，1处为伴行动脉压迫，1处为血管扭曲所致。 结论  IVUS在识别CVD病变与明确病变性质方面有较高敏感性与特异性，有利于中心静脉病变的管理与治疗。

关键词: 维持性血液透析, 中心静脉疾病, 血管内超声, 数字减影血管造影

Abstract: Objective  To evaluate the clinical value of intravascular ultrasonography (IVUS) in the diagnosis and treatment of central venous diseases (CVD) in maintenance hemodialysis (MHD) patients.  Methods  Clinical data of the 5 patients with CVD treated in the Department of Nephrology, Henan Provincial People’s Hospital during February first, 2020 to March first, 2021 were recorded. The location and extent of CVD in the 5 patients were diagnosed by digital subtraction angiography (DSA) and IVUS.  Results  There was no significant difference in evaluating the degree of vascular stenosis between DSA and IVUS, but IVUS detected more lesions than DSA. Among the 5 CVD patients, 2 patients had mild stenosis and 3 patients had occlusion of the central vein. DSA detected 6 lesions, and 3 of them were thrombosis. IVUS detected 8 lesions, and 4 of them were thrombosis, 2 of them were aortic compression, one of them was concomitant artery compression, and one of them was caused by vessel distortion.  Conclusions  IVUS is highly sensitive and specific in identifying CVD and  its primary cause, applicable for the management and treatment of CVD.

Key words: Maintenance hemodialysis, Central venous disease, Intravascular ultrasonography, Digital subtraction angiography

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