摘要
目的观察应用No-touch静脉分离技术分离头静脉构建前臂桡动脉-头静脉血管内瘘的临床效果。方法随机选择济宁医学院附属日照市人民医院自2011年7月~2015年6月构建的前臂桡动脉-头静脉血管内瘘118例,其中采用常规静脉分离技术分离头静脉的76例,采用No-touch静脉分离技术分离头静脉的42例。回顾性分析2组患者血管内瘘术后24月观察期内血管内瘘的并发症、功能障碍率及内瘘通畅率状况。结果 2组患者在年龄构成(χ~2=0.612,P=0.736)、性别构成(χ~2=0.000,P=0.995)、原发病构成(χ~2=0.352,P=0.999)、再次/初次手术比例(χ~2=0.015,P=0.901)、头静脉远端直径(<2mm/>2mm)比例(χ~2=0.001,P=0.978)、合并的血栓性疾病及血栓相关性危险因素(χ~2=0.829,P=0.991)、应用抗血小板药物(χ~2=0.069,P=0.793)及应用抗凝药物(χ~2=0.253,P=0.615)等方面,差异均无统计学意义。观察期内,在内瘘血管狭窄(χ~2=4.267,P=0.039)、假性动脉瘤(χ~2=4.129,P=0.042)、血栓形成(χ~2=3.895,P=0.048)等并发症发生率及血管内瘘功能障碍率(χ~2=3.944,P=0.047)方面,No-touch技术静脉分离组均少于常规技术静脉分离组;No-touch技术静脉分离组血管内瘘通畅率经log-rank检验高于常规技术静脉分离组(χ~2=4.785,P=0.029)。结论应用No-touch技术分离静脉构建前臂桡动脉-头静脉血管内瘘能够减少血管内瘘并发症发生率,延长血管内瘘使用时间。
Objective To investigate the clinical effect of no-touch vein separation technique on the construction of forearm radio-cephalic arteriovenous fistula（AVF）. Method A total of 118 cases having an operation of forearm radio-cephalic AVF from July 2011 to June 2015 were randomly selected; the operation was performed using standard vein separation technique in 76 cases and using no-touch vein separation technique in 42 cases. Complications, dysfunction rate and patency rate of the AVF in the 24 months of follow-up period were retrospectively analyzed. Result There were no significant differences in age（χ2=0.612, P=0.736）, gender（χ2=0.000, P=0.995）, primary disease（χ2=0.352, P=0.999）, secondary/primary operation ratio（χ2=0.015, P=0.901）, distal diameter of cephalic vein（2 mm/2 mm; χ2=0.001, P=0.978）, comorbidities of thrombotic disease and risk factors for thrombosis（χ2=0.829, P=0.991）, and the use of anti-platelet drugs（χ2=0.069, P=0.793） and anticoagulation drugs（χ2=0.253, P=0.615） between the two groups. In the 24 months of follow-up period, vascular stenosis（χ2=4.267, P=0.039）, pseudoaneurysm（χ2=4.129, P=0.042）, thrombosis（χ2=3.895, P=0.048） and dysfunction rate of AVF（χ2=3.944, P=0.047） were lower in the patients using no-touch vein separation technique than in those using standard vein separation technique; postoperative patency rate was higher in the patients using no-touch vein separation technique than in those using standard vein separation technique（x2=4.785, P=0.029）. Conclusion Forearm radio-cephalic arteriovenous fistula（AVF） operation using no-touch vein separation technique can reduce the related complications and increase the usefulness term of the AVF.
作者
付海霞
焦自钊
安茂竹
李凤楼
范晴
盛练芬
FU Hai-xia;JIAO Zi-zhao;AN Mao-zhu;LI Feng-lou;FAN Qing;SHENG Lian-fen(Department of Blood Purification,The People ＂s Hospital of Rizhao Affiliated to Jining Medical College,Ri-zhao 276800,China)
出处
《中国血液净化》
2018年第9期637-640,共4页
Chinese Journal of Blood Purification
