两种血管通路对血液透析患者透析并发症的影响

目的:探讨两种血管通路对血液透析患者透析并发症的影响.方法:回顾性分析2012年1月至2015年1月在我院进行长期血液透析120例患者的临床资料,其中自体动静脉内瘘(AVF)组60例、颈内静脉带袖套隧道导管(CTC)组60例.观察并记录血管栓塞和感染等并发症的发生率.结果:CTC组共进行血液透析7811例次,AVF组共进行血液透析7903例次,AVF组血管栓塞和感染等并发症的发生率方面均明显少于CTC组,差异具有统计学意义(P＜0.05).结论:AVF透析患者的栓塞和感染的发生率较低,是长期血管通路的首选,但在AVF无法建立时,CTC也是理想的血管通路.

慢性肾衰患者AVF的护理体会

血液透析(hemodialysis,HD)是慢性肾衰(chronc renal failure,CRF)患者的有效治疗方法之一,良好的血管通路保证HD,通常要达150～200ml/分的血流量才可反复使用并能保持长期通畅.动静脉内瘘(arterioveneous fistula fistula,AVF)就是一安全的为CRF患者提供长期使用的永久性血管通路,是患者赖以生存的"生命线",因此,对AVF的护理就显得尤为重要.

血管源性搏动耳鸣的介入诊断和治疗研究

目的：回顾性探讨血管源性搏动耳鸣的影像学诊断、发病特点和经血管内介入治疗的可行性和临床效果。方法本组分析了82例动脉和静脉源性搏动耳鸣的DSA不同特征和可能的病理生理机制，对3例颅内动静脉瘘，16例自发性颅底脑膜动静脉瘘，5例外伤性颈动脉海绵窦瘘，2例锁骨下动脉狭窄，3例颈动脉狭窄，1例颅内动脉狭窄，2例椎-基底动脉迂曲延长，2例静脉窦憩室，46例优势引流侧的静脉窦狭窄，2例枕窦狭窄分别经股动脉和股静脉入路，选用螺旋圈、NBCA胶、Balt球囊、自膨式支架和颅内微支架性行栓塞与支架成形处理。结果82例介入手术均获成功，未发生与介入手术相关的并发症，术后搏动性耳鸣在2天内均消失。平均门诊随访5～36月，4例动脉源性耳鸣于介入术后3月复发搏动性耳鸣，经二次栓塞和对症处理后症状缓解；静脉源性搏动性耳鸣病例在支架成形和支架辅助螺旋圈栓塞后均未出现复发征像。结论应用经血管内的诊治方式可能对临床诊断和治疗顽固的搏动性耳鸣提供新的选择途径，有助于为鉴别和研究其他类型的耳鸣提供一定的理论和技术依据。

Objective To retrospectively study clinical features and diagnostic imaging of vasculogeneic pulsatile tin-nitus, and the feasibility and efficacy of transvascular interventional treatment for this condition. Methods Data from 82 cases of arterial or venous pulsatile tinnitus were reviewed. DSA characteristics and possible pathophysiological mechanisms of pulsatile tinnitus in these cases were studied. Diagnoses in this group in-cluded intracranial arterovenous fistula (AVF) (n=3), spontaneous skull base dural AVF (n=16), traumatic ca-rotid-cavernous sinus fistula (n=5), subclavian artery stenosis (n=2), internal carotid artery stenosis (n=3), in-tracranial arterial stenosis (n=1), kinked and/or elongated vertebrobasilar artery (n=2), venous sinus divertic-ulum (n=2), venous sinus stenosis on the dominant drainage side (n=46) and occipital sinus stenosis (n=2). Treatments included embolization and stenting using coils, NBCA glue, Balt balloons, self-expansion stents and intracranial micro-stents via either the femoral artery or femoral vein. Results Procedures were suc-cessful in all cases with no surgery-related complications. Tinnitus disappeared within 2 days after the pro-cedure in all cases. Follow up duration was 5-36 months. Recurrence occurred in 4 cases of arterial tinnitus within 3 months following the initial procedure, which improved after revision embolization or symptom management. There was no recurrence in venous tinnitus cases following stent plastic or stent-coiling embo-lization treatments. Conclusions Endovascular intervention provides a new approach to the diagnosis and treatment of intractable pulsatile tinnitus. It is also effective in differentiating and studying other types of tinnitus.