反复血管内血栓切除术治疗后血液透析患者的肺动脉高压
Pulmonary Hypertension in Hemodialysis Patients Following Repeated Endovascular Thrombectomy.
作者信息
Hsieh Mu-Yang, Lin Lin, Chen Tsung-Yan, Wang Ren-Huei, Huang Su-Chin, Liu HsiuChiao, Lai Chao-Lun, Pu Shih-Yen, Tsai Kuei-Chin, Wu Chih-Cheng
机构信息
Cardiovascular Center, National Taiwan University Hospital, Hsinchu Branch, Hsinchu;
Cardiovascular Center, National Taiwan University Hospital, Hsinchu Branch, Hsinchu; ; College of Medicine, National Taiwan University, Taipei; ; Department of Internal Medicine and Center for Critical Care Medicine, National Taiwan University Hospital Hsinchu Branch, Hsinchu; ; Department of Internal Medicine, College of Medicine; ; Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei;
出版信息
Acta Cardiol Sin. 2016 May;32(3):299-306. doi: 10.6515/acs20150511c.
BACKGROUND
The prevalence of pulmonary hypertension is unusually high in Taiwanese patients with end-stage renal disease. Thrombosis of hemodialysis grafts is common and pulmonary embolism has been reported after endovascular thrombectomy. The aim of this study was to evaluate the relationship between pulmonary hypertension and endovascular thrombectomy of hemodialysis grafts.
METHODS
One hundred and ten patients on hemodialysis via arteriovenous grafts were enrolled in our study. The mean pulmonary artery pressure (PAP) was measured by right heart catheterization. Clinical information was collected by review of medical records. Comorbid cardiopulmonary disease was evaluated by echocardiography and chest X-ray. The history of patient vascular access thrombosis was reviewed from database, hemodialysis records, and interviews with staff at hemodialysis centers.
RESULTS
Fifty-two participants (47%) had pulmonary hypertension diagnosed by right heart catheterization. There was no difference in the number of thrombectomy procedures between patients with and without pulmonary hypertension. Based on multivariate analysis, the number of prior endovascular thrombectomy procedures did not correlate with mean PAP (F-value = 1.10, p = 0.30) nor was it associated with pulmonary hypertension (odds ratio = 0.92, p = 0.17).
CONCLUSIONS
Prior endovascular arteriovenous graft thrombectomies were not associated with pulmonary hypertension or increased mean PAP in end-stage renal disease patients on maintenance hemodialysis.
背景
台湾终末期肾病患者肺动脉高压的患病率异常高。血液透析移植物血栓形成很常见，血管内血栓切除术后有肺栓塞的报道。本研究的目的是评估肺动脉高压与血液透析移植物血管内血栓切除术之间的关系。
方法
110例通过动静脉移植物进行血液透析的患者纳入我们的研究。通过右心导管测量平均肺动脉压（PAP）。通过查阅病历收集临床信息。通过超声心动图和胸部X线评估合并的心肺疾病。从数据库、血液透析记录以及对血液透析中心工作人员的访谈中回顾患者血管通路血栓形成的病史。
结果
52名参与者（47%）经右心导管检查诊断为肺动脉高压。有肺动脉高压和无肺动脉高压的患者之间血栓切除手术的次数没有差异。基于多变量分析，既往血管内血栓切除手术的次数与平均PAP无关（F值=1.10，p=0.30），也与肺动脉高压无关（比值比=0.92，p=0.17）。
结论
既往血管内动静脉移植物血栓切除术与维持性血液透析的终末期肾病患者的肺动脉高压或平均PAP升高无关。
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