中国血液净化

中国血液净化 ›› 2017, Vol. 16 ›› Issue (08): 566-570.doi: 10.3969/j.issn.1671-4091.2017.08.016

• 血管通路 • 上一篇    下一篇

血管鞘技术在动静脉内瘘手术中的应用及术后效果

刘乃全1,孙广萍1   

  1. 中国医科大学附属盛京医院肾脏内科
  • 收稿日期:2017-03-06 修回日期:2017-06-01 出版日期:2017-08-12 发布日期:2017-08-12
  • 通讯作者: 孙广萍 13898878638@163.com E-mail:totti2024@126.com

Application of a vascular sheath technique in the operation of arteriovenous fistula

  • Received:2017-03-06 Revised:2017-06-01 Online:2017-08-12 Published:2017-08-12

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摘要： 目的观察血管鞘技术在动静脉内瘘手术中的应用及术后效果。方法2010 年8 月～2016年11 月在中国医科大学附属盛京医院行动静脉人工内瘘手术的患者共102 例，随机分2 组：传统组49 例，采用头静脉-桡动脉端侧吻合的传统术式；改良组53 例，采用血管鞘置入扩张的头静脉-桡动脉端侧吻合改良术式，比较2 种术式的内瘘通畅率、内瘘血流量和透析时平均血流量。结果102 例手术中有5 例失败，均为传统术式组，其余手术均1 次成功。分别选择术后3 个月、6 个月、12 个月3 个阶段，比较2 组患者术后内瘘血流量(t 值分别为2.429,2.446,2.474,P 值分别0.017，0.016，0.015)、内瘘通畅率(χ2值分别为2.807，5.636，4.508，P 值分别0.094，0.024，0.049)、透析时平均血流量(t 值2.102，2.099，2.199，P 值0.038，0.039，0.037)，除3 个月时2 组通畅率比较差异无统计学意义外，改良组均明显优于传统组，差异有统计学意义。结论动静脉内瘘手术中应用血管鞘技术可以显著提高术后内瘘血流量、通畅率和透析时血流量，操作安全，可作为动静脉内瘘手术的新方法，值得推广。

关键词: 血管鞘, 动静脉内瘘, 血液透析

Abstract: Objective To investigate the application and effect of a vascular sheath technique in the operation of arteriovenous fistula. Methods A total of 102 patients undergone arteriovenous fistula surgery in our hospital from Aug. 2010 to Nov. 2016 were recruited in this study. They were randomly divided into traditional group (n=48), in which the traditional operation of cephalic vein/radial artery anastomosis was used, and improvement group (n=53), in which cephalic vein expanded by intravascular sheath placement/radial artery end to side anastomosis was used. Patency rate of the internal fistula, fistula blood flow and mean blood flow during dialysis were compared between the two groups. Results Fistula surgery failed in 5 cases, of whom all were in traditional group. After the operation for 3, 6 and 12 months, patency rate, blood flow and average blood flow during dialysis were compared between the two groups, and the 3 parameters were better in improvement group than in traditional group, except that the patency rate after the operation for 3 months had no statistical significance (χ2=2.807, 5.636 and 4.508, P=0.094, 0.024 and 0.049 respectively for patency rate; t=2.429, 2.446 and 2.474, P=0.017, 0.016 and 0.015 respectively for blood flow in fistula; t=2.102, 2.099 and 2.199, P=0.038, 0.039 and 0.037 respectively for average blood flow during dialysis). Conclusions The application of a vascular sheath technique in the operation of arteriovenous fistula can significantly improve the blood flow, patency rate and blood access during dialysis. Therefore, this technique can be used as a new method for the operation of arteriovenous fistula.

Key words: Vascular sheath arteriovenous, fistula, hemodialysis