公式预测法在端侧吻合动静脉内瘘手术吻合口设计中应用的效果观察  

The effect of formula prediction method on the design of end-to-side anastomosis of arteriovenous fistula

作　　者：龙湟哲 莫雄 杨鹏 李梅 LONG Huang-zhe;MO Xiong;YANG Peng;LI Mei(Department of Nephrology and,Central Hospital of Shaoyang East Branch,Shaoyang 422000,China;Department of Respiratory Medicine,Central Hospital of Shaoyang East Branch,Shaoyang 422000,China)

机构地区：[1]邵阳市中心医院东院肾内科,邵阳422000 [2]邵阳市中心医院东院呼吸内科,邵阳422000

出　　处：《中国血液净化》2024年第10期775-778,共4页Chinese Journal of Blood Purification

摘　　要：目的探讨如何通过合理设计动静脉吻合口来提高首次动静脉内瘘成熟率。方法根据血管通路手术设计方式分为观察组和对照组,对照组采用传统动静脉内瘘端侧吻合术,观察组采用公式预测法设计吻合口,对比2组手术前头静脉直径、桡动脉直径、桡动脉切口长度、手术后吻合口直径、手术后头静脉流出道直径、肱动脉血流量、内瘘成熟率。结果对照组与观察组手术前头静脉直径、桡动脉直径间差异无统计学意义(F=2.516、0.381,P=0.794、0.861);对照组桡动脉切口长度小于观察组(F=0.099,P<0.001);对照组手术后14 d、28 d、42 d吻合口直径均分别小于观察组(F=3.812、1.735、1.487,均P<0.001);对照组手术后14 d、28 d、42 d头静脉直径均分别小于观察组(F=0.233、1.442、0.002,P=0.012、0.024、<0.001);对照组手术后14 d、28 d、42 d肱动脉血流量均分别小于观察组(F=2.287、1.121、0.019,P<0.001、0.008、0.001);手术后28 d对照组内瘘成熟率低于观察组(χ_(2)=4.167,P=0.041);手术后42 d对照组内瘘成熟率低于观察组(χ_(2)=3.990,P=0.046)。结论采用公式预测法设计内瘘吻合口有利于提高首次内瘘成熟率。Objective To explore how to improve the maturation rate of the first arteriovenous fistula(AVF)through rational design of arteriovenous anastomosis.Methods The control group was treated with traditional end-to-side anastomosis of AVF,and the observation group used the formula prediction method to design the end-to-side anastomosis of AVF.The preoperative cephalic vein diameter and radial artery diameter,radial artery incision length,postoperative anastomotic diameter,postoperative cephalic vein outflow tract diameter,postoperative brachial artery blood flow,and AVF maturity rate were compared between the two groups.Results There were no significant differences in preoperative cephalic vein diameter(F=2.516,P=0.794)and postoperative radial artery diameter(F=0.381,P=0.861)between control group and observation group.The radial artery incision length was shorter in control group than in observation group(F=0.099,P<0.001).In control group after the operation for 14,28 and 42 days,the anastomotic diameter was smaller(F=3.812,1.735 and 1.487 respectively;P<0.001),the cephalic vein diameter was narrower(F=0.233,1.442 and 0.002 respectively;P=0.012,0.024 and<0.001 respectively),and the brachial artery blood flow was lower(F=2.287,1.121 and 0.019 respectively;P<0.001,=0.008 and=0.001 respectively),as compared with those in observation group.The fistula maturation rate was lower in control group than in observation group after operation for 28 and 42 days(χ^(2)=4.167 and 3.990,P=0.041 and 0.046).Conclusions The design of fistula anastomosis using the formula prediction method is beneficial to improve the maturation rate of the first AVF.

关 键 词：动静脉内瘘 端侧吻合术 终末期肾病 

分 类 号：R318.16[医药卫生—生物医学工程]