维持性血液透析患者中心静脉狭窄的介入治疗效果评估

目的 探究维持性血液透析患者中心静脉狭窄的介入治疗疗效。方法 回顾性分析2014年1月至2018年3月收治于海军军医大学（第二军医大学）长征医院、已行中心静脉狭窄介入治疗的维持性血液透析患者的一般临床资料，随访术后的血管通路通畅情况以评估介入治疗的疗效。结果 共纳入82例发生中心静脉狭窄的维持性血液透析患者。其中68例（82.93%）患者既往有中心静脉临时插管病史。82例患者中，中心静脉双支病变13例（15.85%）、单支病变69例（84.15%）；5例（6.10%）为轻度病变、17例（20.73%）为中度病变、35例（42.68%）为重度病变、25例（30.49%）为完全闭塞病变。82例患者中，57例接受经皮腔内血管成形术（PTA）、9例接受经皮腔内支架置入术（PTS）治疗后获得血管再通。术后随访时间12～62个月。术后6个月血管通路通畅率为75.76%（50/66），术后12个月血管通路通畅率为68.18%（45/66），整个随访期间总体血管通路通畅率为59.09%（39/66）。结论 维持性血液透析患者发生中心静脉狭窄后，可影响血管通路使用寿命，对于有症状且不能缓解的患者，建议积极干预，介入治疗是中心静脉狭窄安全、有效的治疗方法。同时，慢性肾脏病患者应尽量避免中心静脉置管操作，以减少中心静脉狭窄发生。

Therapeutic effect of intervention therapy for central venous stenosis in maintenance hemodialysis patients

Objective To explore the efficacy of interventional therapy for central venous stenosis in maintenance hemodialysis patients. Methods The general clinical data of the maintenance hemodialysis patients with central venous stenosis, who received interventional therapy in Changzheng Hospital of Naval Medical University (Second Military Medical University) from Jan. 2014 to Mar. 2018, were retrospectively analyzed, and the patency of vascular access of interventional therapy were followed up. Results A total of 82 maintenance hemodialysis patients with central venous stenosis were enrolled. Six-eight patients (82.93%) had a history of temporary central venous catheterization. Among the 82 patients, 13 (15.85%) had double lesions of central vein and 69 (84.15%) had single lesion; and 5 (6.10%) had mild lesions, 17 (20.73%) had moderate lesions, 35 (42.68%) had severe lesions and 25 (30.49%) had complete occlusion. Of the 82 patients, 57 were treated by percutaneous transluminal angioplasty and 9 by percutaneous transluminal stenting. The followup period ranged from 12 to 62 months after operation. The patency rate of vascular access was 75.76% (50/66) at 6 months postoperatively and 68.18% (45/66) at 12 months postoperatively. The overall patency rate of vascular access was 59.09% (39/66). Conclusion Central venous stenosis of the maintenance hemodialysis patients can affect the life of vascular access. For the patients with symptoms that can not be alleviated, active intervention is recommended. Intervention therapy is safe and effective for the patients with central venous stenosis. Meanwhile, the central venous catheterization shall be avoided if possible to reduce central venous stenosis in the patients with chronic kidney disease.