作　　者： (刘乃全）; (孙广萍）;

机构地区： 中国医科大学附属盛京医院肾脏内科,沈阳110000

出　　处： 《中国血液净化》 2017年第8期566-570,共5页

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(χ~2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。 Objective To investigate the application and effect of a vascular sheath technique in the oper- ation 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 tradition- al group （n=48）, in which the traditional operation of cephalic vein/radial artery anastomosis was used, and im- provement 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 dur- ing 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 im- provement 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 ap- plication 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.

关 键 词： 血管鞘 动静脉内瘘 血液透析