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。
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.
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