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预防血液透析动静脉通路血栓形成的药物和置管相关策略

Author
Michael Allon, MD
Section Editors
Jeffrey S Berns, MD
David L Cull, MD
Deputy Editors
Alice M Sheridan, MD
Kathryn A Collins, MD, PhD, FACS
Translators
程叙扬, 副教授

引言

血液透析需要能够提供快速体外血流的血管通路。目前，自体动静脉(arteriovenous, AV)瘘和动静脉移植物可最好地满足这些要求。 (参见“长期血液透析通路用动静脉瘘及人工血管内瘘”)

血液透析动静脉通路失功主要由不可逆性血栓形成引起。90%以上的血栓形成性移植物存在狭窄病变，表明对具有血流动力学意义的狭窄进行抢先治疗可能预防通路形成血栓。然而，随机对照试验显示该方法的结果令人失望。 (参见“经皮介入治疗动静脉通路狭窄”和“血液透析血管通路相关静脉狭窄的支架治疗”)

其他预防移植物血栓形成的策略可能有益。本专题将概述预防血管通路血栓形成的药物策略和置管策略。

新生内膜增生

血液透析动静脉瘘和移植物的血管通路狭窄由内皮细胞损伤引发，内皮细胞损伤导致内皮细胞表面黏附分子上调。随后白细胞黏附于损伤且激活的内皮，导致趋化因子和促有丝分裂因子释放并作用于血管平滑肌细胞，从而增强平滑肌细胞的迁移和增殖[1-3]。

促进新生内膜增生和纤维肌性增生的其他因素包括：血液湍流形成的剪应力[4,5]，以及导致过度机械牵拉的吻合处周围弹性不匹配[6]。活化的血小板和炎症细胞也可分泌直接损伤血管壁的氧化剂和其他毒素[7]。最后，狭窄病变的血管成形术会加剧新生内膜增生，从而导致再狭窄加速[8]。

      

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Literature review current through: 2017-06 . | This topic last updated: 2017-06-28.
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