中国血液净化

中国血液净化 ›› 2018, Vol. 17 ›› Issue (09): 637-640.doi: 10.3969/j.issn.1671-4091.2018.09.014

• 血管通路 • 上一篇    下一篇

应用No-touch 静脉分离技术构建前臂桡动脉-头静脉血管内瘘的临床效果

付海霞1,焦自钊1,安茂竹1,李凤楼1,范晴1,盛练芬1   

  1. 1. 济宁医学院附属日照市人民医院血液净化科
  • 收稿日期:2018-05-21 修回日期:2018-07-17 出版日期:2018-09-12 发布日期:2018-08-24
  • 通讯作者: 焦自钊jiaozzrz@sina.com E-mail:jiaozzrz@sina.com

The clinical effect of no-touch vein separation technique on the construction of forearm radio-cephalic arteriovenous fistula

  • Received:2018-05-21 Revised:2018-07-17 Online:2018-09-12 Published:2018-08-24

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摘要： 【摘要】目的观察应用No-touch 静脉分离技术分离头静脉构建前臂桡动脉-头静脉血管内瘘的临床效果。方法随机选择济宁医学院附属日照市人民医院自2011 年7 月～2015 年6 月构建的前臂桡动脉-头静脉血管内瘘118 例，其中采用常规静脉分离技术分离头静脉的76 例，采用No-touch 静脉分离技术分离头静脉的42 例。回顾性分析2 组患者血管内瘘术后24 月观察期内血管内瘘的并发症、功能障碍率及内瘘通畅率状况。结果2 组患者在年龄构成(χ2=0.612, P=0.736)、性别构成(χ2=0.000, P=0.995)、原发病构成(χ2=0.352, P=0.999)、再次/初次手术比例(χ2=0.015, P=0.901)、头静脉远端直径(＜2mm/＞2mm)比例(χ2=0.001, P=0.978)、合并的血栓性疾病及血栓相关性危险因素(χ2=0.829,P=0.991)、应用抗血小板药物(χ2=0.069,P=0.793)及应用抗凝药物(χ2=0.253,P=0.615)等方面，差异均无统计学意义。观察期内，在内瘘血管狭窄(χ2=4.267,P=0.039)、假性动脉瘤(χ2=4.129,P=0.042)、血栓形成(χ2=3.895,P=0.048)等并发症发生率及血管内瘘功能障碍率(χ2=3.944, P=0.047)方面，No-touch 技术静脉分离组均少于常规技术静脉分离组；No-touch 技术静脉分离组血管内瘘通畅率经log-rank 检验高于常规技术静脉
分离组(χ2=4.785,P=0.029)。结论应用No-touch 技术分离静脉构建前臂桡动脉-头静脉血管内瘘能够减少血管内瘘并发症发生率，延长血管内瘘使用时间。

关键词: No-touch, 静脉分离, 头静脉, 挠动脉, 血管内瘘

Abstract: 【Abstract】Objective To investigate the clinical effect of no- touch vein separation technique on the construction of forearm radio-cephalic arteriovenous fistula (AVF). Method A total of 118 cases having an operation of forearm radio-cephalic AVF from July 2011 to June 2015 were randomly selected; the operation was performed using standard vein separation technique in 76 cases and using no-touch vein separation technique in 42 cases. Complications, dysfunction rate and patency rate of the AVF in the 24 months of follow-up period were retrospectively analyzed. Result There were no significant differences in age (χ2=0.612, P=0.736), gender (χ2=0.000, P=0.995), primary disease (χ2=0.352, P=0.999), secondary/primary operation ratio (χ2=0.015, P=0.901), distal diameter of cephalic vein (＜2 mm/＞2 mm; χ2=0.001, P=0.978), comorbidities of thrombotic disease and risk factors for thrombosis (χ2=0.829, P=0.991), and the use of anti-platelet drugs (χ2=0.069, P=0.793) and anticoagulation drugs (χ2=0.253, P=0.615) between the two groups. In the 24 months of follow-up period, vascular stenosis (χ2=4.267, P=0.039), pseudoaneurysm (χ2=4.129, P=0.042), thrombosis (χ2=3.895, P=0.048) and dysfunction rate of AVF (χ2=3.944, P=0.047) were lower in the patients using no-touch vein separation technique than in those using standard vein separation technique; postoperative patency rate was higher in the patients using no-touch vein separation technique than in those using standard vein separation technique (c2=4.785, P=0.029). Conclusion Forearm radio-cephalic arteriovenous fistula (AVF) operation using no-touch vein separation technique can reduce the related complications and increase the usefulness term of the AVF.

Key words: No-touch, Vein separation, Cephalic vein, Radial artery, Vascular fistula