中国血液净化

中国血液净化 ›› 2018, Vol. 17 ›› Issue (02): 99-101.doi: 10.3969/j.issn.1671-4091.2018.02.006

• 血管通路 • 上一篇    下一篇

29 例ACUSEAL 人工血管动静脉内瘘建立的临床观察

杨涛1,温静1,任树风1,詹申1,王玉柱1   

  1. 1. 北京大学第三医院海淀院区，北京市海淀医院肾内科
  • 收稿日期:2017-10-23 修回日期:2017-12-14 出版日期:2018-02-12 发布日期:2018-02-12
  • 通讯作者: 王玉柱wyz4417@sina.com E-mail:yangtaodoct@163.com

Clinical observation on the ACUSEAL graft for hemodialysis access in 29 cases

  • Received:2017-10-23 Revised:2017-12-14 Online:2018-02-12 Published:2018-02-12

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摘要： 目的探讨ACUSEAL 人工血管动静脉内瘘的建立方法，观察早期穿刺使用情况。方法收集入组患者基线资料，超声检查计划手术侧的肱动脉及上臂静脉内径；人工血管与自体血管端侧吻合，建立U 型人工血管袢。术后观察前臂肿胀情况，根据患者治疗需要及前臂肿胀情况行人工血管内瘘穿刺，透析结束后拔针局部按压15～20min。结果入组患者中有17 例(58.6%)患者同时患有糖尿病，大部分患者既往有多次置管或动静脉内瘘建立史。吻合动脉平均直径为(3.81±0.67)mm，吻合静脉平均束臂直径为(4.46±1.47)mm。人工血管动静脉内瘘均一次性建立成功，术后前臂未见中重度肿胀，24 例(82.8% )患者在术后1 周之内开始穿刺，且76.2%的中心静脉置管者术后1 周内拔除导管。结论ACUSEAL 人工血管内瘘建立后较少出现肢体肿胀，避免了中心静脉置管或缩短了其留置时间，为内瘘的早期穿刺使用提供了可能。

关键词: 人工血管, 动静脉内瘘, 血液透析

Abstract: Objective To investigate the implementation of the ACUSEAL graft for hemodialysis access and early cannulation. Methods The clinical data of the patients who underwent ACUSEAL graft for hemodialysis access were collected. The internal diameters of brachial artery and upper arm vein in surgical side were determined by ultrasonography. Artificial blood vessel and autovessel were connected by side and end anastomosis to construct a U-shaped artificial vascular loop. Forearm swelling was observed after the operation. ACUSEAL graft fistula was punctured in the case of forearm swelling or treatment need. The puncture site was pressed for 15- 20 minutes after hemodialysis access. Results Seventeen patients (58.6%) were found to have diabetes. Most of the patients had the history of central venous catheterization or arteriovenous fistula. The mean diameter of the anastomostic arteries was 3.81±0.67mm, and the mean diameter of veins after applying tourniquet was 4.46±1.47mm. All the operations were completed successfully. No obvious limb swelling was found. The ACUSEAL graft was used for hemodialysis access after the operation for one week in 24 patients (82.8%), and the central venous catheters were removed after the operation for one week in 76.2% patients. Conclusion The use of ACUSEAL graft to establish arteriovenous fistula avoided limb swelling, shortened the placement of central venous catheters, and provided the possibility to earlier use the arteriovenous fistula.

Key words: Vascular graft, Arteriovenous fistula, Hemodialysis