摘要
目的:探讨血液透析用动-静脉内瘘术在围手术期的处理原则以及决定手术成败的相关因素和干预措施。方法:分析16年前后2个阶段原发病的变化、患者术前血管条件的不同、术中采取不同术式及术后采取不同处理方法与手术成功率、内瘘血流量的关系并做相关数据统计学处理。结果:第二阶段继发性肾脏病的比例明显上升,与第一阶段比较差异有统计学意义(P<0.01);决定手术成功率的因素为原发病、术前上肢外周血管保护好坏、内瘘建立时机、吻合方式及术后处理措施;血流量与手术方式有关,采取钛轮钉吻合的瘘成熟后的血流量为(210.20±45.42)ml/min,端端缝合吻合的内瘘成熟后血流量为(281.10±27.57)ml/min,端侧吻合血流量为(323.40±52.45)ml/min,3种术式比较差异均有统计学意义(P<0.05)。结论:时代的变迁导致慢性肾功能衰竭患者原发病发生变化,继而导致造瘘患者血管条件和内环境的变化,因此要提高手术成功率不能单纯强调手术技巧,而应从围手术期的每一个环节着手,包括术前血管的保护、造瘘血管的选择、术式选择、术中操作要点及术后抗凝、抗血小板治疗等。
Objective：To explore the perioperative treatment principle for arteriovenous fistulas of hemodialysis,the related factors to the success of operations and the intervention measures.Methods：1820 cases in the 2 periods from 1992to 2000 and from 2001 to 2008 were selected,and the relation of the change of primary diseases,the difference of their blood vessel condition before operation,different operation methods and different treatment after operation to the successful rate of operation and fistulas blood flow was analyzed and statistical analysis was made to the related data.Results：The ratio of secondary renal disease in the second period was much bigger and of significant difference with that in the first period（P0.01）;the factors to decide the success of operation included primary disease,the protection of peripheral vessels of upper limbs before operation,the right time to set up fistulas,methods of anastomosis and post-operation treatment measures;the blood flow was correlated to the operation methods,the blood flow after mature formation fistulas anastomosed with cyclic titanium nail was 210.20±45.42 ml/min,the blood flow after mature formation fistulas anastomozed with end-to-end neurorrhaphy was 281.10±27.57 ml/min while that with end-to-side neurorrhaphy was 323.40±ml/min,there existed a statistical difference among the 3 methods（P0.05）.Conclusions：Time going leads to the change of primary diseases in patients with chronic renal failure,and then to the changes of blood vessels and the inner circumstances in patients of fistulization;the increase of the successful rate of operation should not only depend on performance skills,but also on each link in perioperative period,including the protection of blood vessels before operation,the selection of blood vessels for fistulization,the selection of operation methods,the performance in operation and the treatment of anticoagulation and antiplatelet.
出处
《重庆医科大学学报》
CAS
CSCD
北大核心
2010年第3期461-464,共4页
Journal of Chongqing Medical University
关键词
动-静脉内瘘
手术
血液透析
血流量
Arteriovenous fistulas
Operation
Hemodialysis
Blood flow
