桡动静脉血透通路术中动脉压测定及其应用

Detection of the Stubbed Radial Arterial Pressure and Clinical Application during the Procedure of Radial-cephalic Hemodialysis Access

目的:研究桡动静脉血透通路中测定桡动脉残端压的方法及其临床应用。方法:自2005年12月—2007年4月,对29例行桡动静脉内瘘术的尿毒症患者,术中测定桡动脉血压和残端压。术中游离桡动脉,桡动脉测压装置调零,测压针穿刺桡动脉,读取桡动脉血压。用血管夹阻断穿刺点近端的桡动脉,读取桡动脉残端压。结果:阻断前桡动脉血压68～149mmHg,平均105.38±18.34mmHg。桡动脉残端压30～138mmHg,平均95.62±20.18mmHg。桡动脉阻断前后动脉压差超过30mmHg或阻断后桡动脉残端压绝对值小于70mmHg者(7例),采用桡动脉-头静脉端侧吻合;否则采用端端吻合(22例)。内瘘手术技术成功率100%。随访6～18个月,无手指缺血征象,手指肌力V级,随访期内瘘通畅率100%。结论:术中测定桡动脉血压和残端压简单、方便,可指导血管吻合方式,预防手缺血。

Objective：To study the stubbed pressure after clamping the radial artery during the procedure of radial-cephalic fistula and the clinical application.Methods：Survey the stubbed pressure during the procedure of radial-cephalic fistula on 29 uremia patients from December 2005 to April 2007.Mobilized the radial artery and make sure the pressure measurement system would be adjusted.Punctured the radial artery with measurement device,then read the pressure.Results：The pressure before clamping the radial artery was between 68 to 149mmHg.Its mean was 105.38±18.34mmHg.The stubbed pressure after clamping the radial artery was between 30 to 138mmHg.Its mean was 95.62±20.18mmHg.There were 7 patients people whose stubbed pressure decreased more than 30mmHg or steped down lower than 70mmHg constructed arteriovenous fistula with end-to-side radial-cephalic anastomosis.The other use the end-to-end radial-cephalic anastomosis.All of the operations were succeed.The length of follow-up visit was from 6 to 18 months.All patients had no symptoms of the upper extremity ischemia,no paralysis of the hands.The patency rate was 100% during the follow up.Conclusion：It is a simple and convenience method to measure the stubbed blood pressure of the radial artery during the arteriovenous fistula procedure.The perfusion pressure of the hand after clamped the radial artery could be get directly and guide the clinical application.