肘下与肘上高位动静脉内瘘应用于尿毒症患者血液透析的效果  

Effects of Below-the-Elbow and Above-the-Elbow High Arterio-Venous Fistulas Applied to Hemodialysis on Patients with Uremia

作　　者：陆猛桂[1,2] 

机构地区：[1]广西医科大学第六附属医院 [2]玉林市第一人民医院肾内科,玉林市537000

出　　处：《广西医学》2014年第5期608-610,共3页Guangxi Medical Journal

基　　金：广西玉林市科学研究与技术开发项目(13062003)

摘　　要：目的比较肘下与肘上高位动静脉内瘘应用于尿毒症患者血液透析的效果。方法 45例前臂内瘘堵塞或前臂血管条件差无法在该部位手术的尿毒症患者,按手术方法不同分为肘下高位动静脉内瘘组(肘下内瘘组)25例和肘上高位动静脉内瘘组(肘上内瘘组)20例。肘下内瘘组行桡动脉-正中静脉或其交通静脉端侧吻合术,肘上内瘘组行肱动脉-肘正中静脉或贵要静脉端侧吻合术。对比两组手术时间、术中出血量、手术成功率、血液透析径路、血流量、通畅率,术后心力衰竭、肢体肿胀、窃血综合征以及假性动脉瘤发生率等。结果两组患者手术均获得成功,均通畅。肘下内瘘组血液透析径路长于肘上内瘘组(P<0.05),手术时间、术中出血量均明显少于肘上内瘘组(P<0.05)。肘下内瘘组血流量稍低于肘上内瘘组,但差异无统计学意义(P>0.05)。两组均未发生假性动脉瘤,肘下内瘘组术后无充血性心力衰竭、肢体肿胀、窃血综合征等并发症。肘上内瘘组术后发生充血性心力衰竭3例(15.0%)、肢体肿胀3例(15.0%)、窃血综合征1例(5.0%)。肘上内瘘组充血性心力衰竭、肢体肿胀发生率均明显高于肘下内瘘组(P<0.05),两组窃血综合征发生率比较,差异无统计学意义(P>0.05)。结论肘下与肘上动静脉内瘘均能满足血液透析要求,但前者比后者并发症少、获得较长血透径路,更具优势。Objective To compare the effects between the below-the-elbow high arterio-venous fistula （BEHAVF） and the above-the-elbow high arterio-venou fistula （ AEHAVF ） applied to hemodialysis patients with uremia .Methods Forty-five patients with uremia ,whose forearm fistulas were blocked or whose vascular conditions of the forearm were too bad to receive an operation ,were divided into BEHAVF group （ 25 cases ） and AEHAVF group （ 20 cases ） according to the different surgical methods .The BEHAVF group was given an end-to-side anastomosis of the radial artery and the median vein or the perforating vein .The AEHAVF group was given an end-to-side anastomosis of the brachial artery and the median cubital vein or the basilic vein .The operative time ,intraoperative blood loss ,operation success rate , vascular access in hemodialysis ,blood flow ,patency rate ,and the incidences of postoperative heart failure ,arm edema , steal syndrome and pseudoaneurysm were compared between two groups .Results The operations of two groups were successful and smooth .The vascular accesse in hemodialysis of BEHAVF group was longer than that of AEHAVF group （P〈0.05）,and the operative time and intraoperatve blood loss were less than those of AEHAVF group （P〈0.05）. The blood flow was less in the BEHAVF group in contrast with that in the AEHAVF group ,which showed no significant difference between two groups（P〉0.05）.Pseudoaneurysm did not occur in the two groups .Postoperative heart failure ,arm edema and steal syndrome did not occur in the BEHAVF group .There were 3 cases （ 15%） of congestive postoperative heart failure , 3 cases （ 15%） of arm edema and 1 case （ 5%） of steal syndrome in the AEHAVF group .The incidences of postoperative heart failure and arm edema in the BEHAVF group were significantly higher than those in the AEHAVF group （P〈0.05）.There was no significant difference in the steal syndrome between two groups （P〉0.05）. Conclusion Both BEHAVF and AEHAVF can meet the require

关 键 词：尿毒症 肾透析 动静脉内瘘 肘下静脉 肘上静脉 

分 类 号：R692.5[医药卫生—泌尿科学]