下肢即穿式人工血管在血液透析中的临床应用  

Use of the early cannulation prosthetic graft(Gore Acuseal) as a lower extremity prosthetic hemodialysis access

作　　者：汤兵 李远明[2] 徐勇[2] 刘新新 侯蓓 伍锟[2] 

机构地区：[1]长沙捷奥医院肾脏科,长沙410003 [2]中南大学湘雅三医院血液净化中心,长沙410008

出　　处：《中国血液净化》2017年第11期778-780,共3页Chinese Journal of Blood Purification

摘　　要：目的探索血液透析中上肢血管耗竭或中心静脉狭窄时新型即穿式人工血管在下肢动静脉内瘘中的建立方法以及安全性、有效性。方法对长沙捷奥医院肾脏科2016年12月以来,在下肢股浅动脉和大隐静脉间进行的15例GORE?ACUSEAL即穿式人工血管动静脉内瘘手术进行临床研究,随访观察该手术的首次穿刺时间、开放率、血清肿、栓塞率、窃血综合征、假性动脉瘤以及感染发生率等并发症。结果首次穿刺时间为(136.8±97.2)h(24~384h),平均随访(3.6±1.6)个月(1.7~6.0月),初级通畅率为100%,初期血流量200~230 ml/min,未见血清肿、血栓、假性动脉瘤及与内瘘血管直接相关的感染等并发症。因窃血综合征切除人工血管1例。护士普遍反映血管穿刺较普通人工血管更方便,透后15min穿刺点即可以止血,未见血肿。12例术后早期即拔除中心静脉导管或结扎闭塞原内瘘,随访未见中心静脉狭窄并发症。随访血流量均大于250ml/min。结论下肢即穿式人工血管应用于血液透析,安全有效,并发症少,值得在上肢血管耗竭或中心静脉狭窄的血液透析患者中推广。Objectives To report the safety and effectiveness of the Gore Acuseal Graft used as a lower extremity prosthetic vascular access for chronic hemodialysis patients who have exhausted upper extremity vascular access or have central venous stenosis. Methods Between December 2016 and May 2017, 15 pa-tients who underwent implantation of the Gore Acuseal prosthetic AV access were included in the study. The graft configuration was superficial femora-saphenous for all patients. Follow-up studies including the time to first cannulation, patency rate, seroma rate, access thrombosis, steal syndrome, pseudo-aneurysm and infec-tion were recorded. Results Graft implantation was technically successful in all 15 patients. No patient was lost during a mean follow-up time of 3.6 ＆#177; 1.6 months （1.7~6 months）. Mean time to first cannulation was 136.8＆#177;97.2 hrs （24~384 hrs）. Primary functional potency rate was 100%. Primary blood flow rate was 200~230 ml/min. First puncture time was 136.8＆#177;97.2 hrs （24~384 hrs）, and average follow-up period was 3.6＆#177;1.6 months （1.7~6.0 months）. Seroma, thrombosis, pseudo-aneurysm and graft infection were never observed. Steal syndrome occurred in one patient and the graft was removed. Cannulation is easier than other types of regular prosthetic access reported by nurses. Cannulation site usually stop bleeding in 15 minutes with pres-sure on the site, and no hematoma was observed. Central venous catheter was removed, or the dysfunctional fistula was ligated at early postoperatively stage in 12 patients. Central venous stenosis complications were not observed. Follow-up found that blood flow rate was greater than 250 ml/min in all patients. Conclusion Lower extremity Gore Acuseal graft implantation was safe and effective with less complication. It can be widely applied for chronic hemodialysis patients who have exhausted upper extremity vascular access or have central venous stenosis.

关 键 词：早期 人工血管 下肢 血液透析 

分 类 号：R318.16[医药卫生—生物医学工程]