关键词: 臂丛神经阻滞, 局部浸润麻醉, 血液透析, 经皮腔内血管成形术, 自体动静脉内瘘

Abstract: Objective  To investigate the efficacy of trans-axillary approach of brachial plexus nerve block for percutaneous transluminal angioplasty (PTA) in hemodialysis patients.   Methods  A total of 60 patients treated with PTA due to autologous arteriovenous fistula stenosis in the Department of Nephrology of Qiqihar Jianhua Hospital from December 2020 to December 2021 were enrolled in this study. They were divided into control group (local infiltration anesthesia, n=30) and brachial plexus block group (axillary approach of brachial plexus block, n=30). After the operation, pain score, pain management satisfaction, operation time, surgical and anesthetic complications, stenosis of the internal fistula, and primary patency rate of the internal fistula were assessed.   Results The visual analogue scale (VAS) of the control group was higher than that of the brachial plexus block group (t=2.571, P=0.011). The brachial plexus block group had a higher pain management satisfaction score (t=-5.305, P<0.001). There was no statistical difference in operation time between the two groups (t=-0.270, P=0.788). In the control group, two patients with arterial lesions presented with arterial spasm during operation, which was relieved by stopping endoluminal manipulation and medication treatment. No surgical and anesthesia complications occurred in the brachial plexus block group. There were statistical differences before and after the surgery in diameter of fistula stenosis (t=-52.789 and -44.140, P＜0.001), natural blood flow in internal fistula (t=-16.741 and -19.528, P＜0.001) and blood flow during dialysis (t=-8.776 and -9.550, P＜0.001) both in the control group and the brachial plexus block group. However, there were no significant differences after PTA in diameter of fistula stenosis (t=0.374, P=0.710), natural blood flow in internal fistula (t=1.017, P=0.313), and blood flow during dialysis (t=-1.181, P=0.242) between the two groups. The primary patency rates after PTA for 1, 3, 6, and 12 months were 93%, 87%, 54%, and 21% respectively in the control group, and were 93%, 90%, 61%, and 25% respectively in the brachial plexus block group, without statistical significances between the two groups (Log Rank: c2=0.307, P=0.579). The primary patency rates in the two groups were also compared monthly in January (c2=0.001, P=0.970), March (c2=0.213, P=0.644), June (c2=0.283, P=0.595) and December (c2=0.087, P=0.768), without statistical differences between the two groups.  Conclusion  Brachial plexus block anesthesia provides safe and effective analgesia during PTA for the treatment of arteriovenous fistula stenosis in dialysis patients, with higher patient satisfaction than local infiltration anesthesia, and has no effect on the 12-month primary patency rate.

Key words: Brachial plexus block, Local infiltration anesthesia, Hemodialysis, Percutaneous transluminal angioplasty, Arteriovenous fistula