Arteriovenous Hemoaccess-Related Pulmonary Arterial Hypertension-Effect of Access Flow Reduction-A Case Report

洗腎動靜脈廔管相關的肺動脈高血壓－廔管減流的效用：一個病例報告

林佩瑩(Pei-Ying Lin) ； 高芷華(Tze-Wah Kao) ； 郭炳宏(Ping-Hung Kuo) ； 余忠仁(Chong-Jen Yu) ； 楊泮池(Pan-Chyr Yang)

《胸腔醫學》 23卷4期 (2008/08) Pp. 304-309

https://doi.org/10.29806/TM.200808.0011

摘要

因洗腎動靜脈廔管所引起肺動脈高血壓的發生率常被低估。當洗腎病患出現難以解釋的呼吸窘迫時這是一個必須納入的鑑別診斷。過去的報告曾經指出，成功的腎臟移植，腹膜透析，以及人工洗腎導管的使用都可以降低這類病患的肺動脈壓。此名病患在診斷之初有嚴重肺動脈高壓，但她堅持持續使用動靜脈廔管。然而，在高流速廔管結紮並以低流速廔管取代後，病患的肺動脈高壓、呼吸窘迫、以及血氧濃度均得到顯著的改善。即便肺動脈壓無法降低至正常值，病患的生活品質得到良好的改善。本病歷報告提供了處理此類病患的另一種思考角度。

關鍵字

肺動脈高壓 ； 動靜脈廔管 ； 洗腎

並列摘要

Arteriovenous access-related pulmonary arterial hypertension is a previously under-diagnosed complication in hemodialysis patients, and should be kept in mind when hemodialysis patients using surgically created arteriovenous access encounter unexplained dyspnea. It was found that successful renal transplantation, peritoneal dialysis and hemodialysis with a permanent dialysis catheter can reduce pulmonary arterial pressure in this group of patients. The patient reported herein had severe pulmonary arterial hypertension but insisted on using an arteriovenous fistula for hemodialysis. Her pulmonary arterial pressure, dyspnea and oxygenation improved after ligation of the original high-flow arteriovenous fistula and creation of a low-flow alternative. Although the pulmonary arterial pressure did not decrease to a normal range, the patient's clinical symptoms and quality of life clearly improved. This case may provide new insight into the management of pulmonary arterial hypertension in this group of patients.

並列關鍵字

pulmonary arterial hypertension ； arteriovenous access ； hemodialysis