臂丛神经阻滞对动静脉造瘘术后血管通畅率的影响  

Effect of Brachial plexus block on vascular patency rate in patients undergoing arteriovenous fistula forming surgery

作　　者：杨昆鑫 陆迪涵[1] 刘艺 冯霞[1] YANG Kunxin;LU Dihan;LIU Yi;FENG Xia(Department of Anesthesiology,the First Affiliated Hospital of Sun Yat-sen University,Guangzhou 510080,China)

机构地区：[1]中山大学附属第一医院麻醉科,211112

出　　处：《临床外科杂志》2024年第6期593-598,共6页Journal of Clinical Surgery

基　　金：国家自然科学基金面上项目(82371189、82071224);国家自然科学基金青年项目(82301354);广州市临床高新技术项目(2023P-GX10)。

摘　　要：目的比较臂丛神经阻滞(brachial plexus block,BPB)与其他麻醉方法对终末期肾衰竭(end-stage renal disease,ESRD)病人动静脉造瘘术后通畅率等结果的影响,以优化ESRD病人造瘘的围术期麻醉管理方案。方法本研究第一部分为回顾性队列研究:选择2017年1月1日~2022年8月30日行动静脉造瘘术的ESRD病人,根据麻醉方式不同分为BPB组180例和局部麻醉(local anesthesia,LA)组332例,收集两组一般资料、造瘘管通畅率、术后并发症和其他随访数据并进行比较。第二部分Meta分析:检索中国知网、万方、PubMed、Web of Science、Cochrane Library和Scopus数据库自建库至2024年4月所有相关文献,根据纳排标准进行文献筛选和数据提取,使用RevMan 5.3进行数据分析。结果第一部分回顾性研究显示,BPB组与LA组术后原始通畅率在1、12个月比较差异有统计学意义(96.6%vs 91.7%,P<0.05;68.3%vs 59.0%,P<0.05),BPB组与LA组干预后通畅率在1、3、12个月比较差异有统计学意义(100.0%vs 95.5%,P<0.05;96.5%vs 86.3%,P<0.05;85.0%vs 70.8%,P<0.05),两组术后感染、血栓和血肿并发症比较差异无统计学意义(P>0.05)。第二部分Meta分析结果显示,BPB较其他麻醉方法造瘘术后原始通畅率明显升高(SMD=1.51,95%CI 1.17~1.96,P<0.05),术后感染和血栓并发症比较差异无统计学意义(P>0.05)。结论BPB对维持动静脉造瘘术后的长期通畅率较其他麻醉方法具有明显优势,且具有与其他麻醉方式相当的安全性。Objective In order to optimize the perioperative anesthesia management for ESDR patients undergoing arteriovenous fistula,we compared the impact of brachial plexus nerve block and other anesthesia methods on the long-term patency rate of arteriovenous fistula after surgery.Methods In this study,2 parts of work were conducted.Part I,a retrospective cohort study:ESRD patients who underwent arteriovenous fistulas in the First Affiliated Hospital of Sun Yat-sen University from January 1,2017 to August 30,2022 were selected.According to the method of anesthesia,patients were divided into BPB group(180 cases)and local anesthesia(LA)group(332 cases).The basic characteristics,postoperative follow-up,fistula patency rate and postoperative complications were collected and statistically analyzed.Part II:Meta-analysis:All relevant literatures from CNKI,Wanfang,PubMed,Web of Science,Cochrane Library and Scopus databases were searched up to April 2024,literature screening and data extraction were conducted according to inclusion and exclusion criteria,and data analysis was performed using RevMan 5.3.Results The first part of the retrospective study showed that the primary patency rate in the BPB group was significantly different from that in the local anesthesia group at 1 month and 12 months postsurgery(96.6%vs 91.7%,P<0.05;68.3%vs 59.0%,P<0.05),and the patency rate after intervention was significantly different at 1 month,3 months and 12 months(100.0%vs 95.5%,P<0.05;96.5%vs 86.3%,P<0.05;85.0%vs 70.8%,P<0.05).There was no significant difference in postoperative infection,thrombosis and hematoma complications(P>0.05).The second part of the Meta-analysis results showed that there was a statistically significant difference in the primary patency rate of BPB compared with other anesthesia methods(SMD=1.51,95%CI:1.17~1.96,P<0.05),and there was no statistically significant difference in postoperative infection and thrombosis complications(P>0.05).Conclusion As a consequence,BPB has obvious advantages over other anesthesia methods i

关 键 词：臂丛神经阻滞 肾功能衰竭 动静脉瘘 区域麻醉 通畅率 

分 类 号：R614[医药卫生—麻醉学]