髂外静脉穿刺建立临时血液透析通路的临床与解剖研究

Clinical and anatomic research on the establishment of temporary route for hemodialysis through the puncture of the external iliac vein

目的经髂外静脉穿刺建立血液透析临时血管通路。方法①80例急、慢性肾功能衰竭患者随机分为对照组和观察组,对照组采用股静脉穿刺、观察组经髂外静脉穿刺行血液透析,观察穿刺成功率、皮下血肿发生率和血流量不足发生率。②解剖44例人体标本并对髂外静脉定位测量。结果①穿刺成功率:观察组为97.50%,对照组为95.00%;皮下血肿发生率:观察组为2.50%,对照组为5.00%。两组比较,差异均无统计学意义(χ2分别=0.00、0.00,P均>0.05)。血流量不足发生率:对照组为22.50%,观察组为5.00%,差异有统计学意义(χ2=5.16,P<0.05)。②右侧髂外静脉较粗直,走向较恒定;左侧髂外静脉粗细不均,走行变异较大。当穿刺针在腹股沟处插入左、右髂外静脉长轴时,针体与股静脉延长线的角度:左侧为20°～30°,平均(25.50±2.42)°;右侧为15°～30°,平均(18.67±4.77)°。针体与股部体表的角度:左侧为30°～45°,平均(38.17±7.71)°;右侧为15°～45°,平均(30.42±8.05)°。结论①髂外静脉穿刺建立临时血管通路首选右侧髂外静脉,穿刺时,建议针尖朝肚脐方向,与体表成30°～45°角进针;如必须选择左侧,建议针尖方向偏内上15°～30°,与体表成15°～45°进针。②髂外静脉穿刺行血液透析操作安全简单,血流量充分,可作为血液透析临时性血管通路的替代途径。

Objective To establish the temporary vascular route for hemodialysis through puncture of the external iliac vein.Methods ①Eighty cases of acute and chronic renal failure patient were randomly divided into control and observed groups.The puncture of the femoral vein was performed in the control group and the puncture of the external iliac vein was performed in the observed group for hemodialysis.The successful rate of puncture,incidence of the subcutaneous hemotoma and incidence of blood flow deficiency were observed.②Forty-four human cadaveric specimen were dissected and the external iliac veins were measured.Results ①The successful rate of puncture was 97.50% in the observed group and 95.00% in the control one.The incidence of subcutaneous hemotoma was 2.50% in the observed group and 5.00% in the control one.The difference had no statistical significance compared between both groups（χ2=0.00,0.00,P0.05）.The incidence of blood flow deficiency was 22.50% in the control group and 5.00% in the observed one.The difference had statistical significance（χ2=5.16,P0.05﹚.②The configuration of the right external iliac was wide and straight,the trend was more constant,but the diameter of the left external iliac vein was uneven,and the variation of the trend was much.The angle between the needle and the extension line of the femoral vein was 25.50±2.42（20～30） degree at the left side,and 18.67±4.77（15～30） degree at the right side when the puncture needles were inserted into the left and right external iliac veins at the inguinal regions.The angles of the needle body and the body surface of the thigh were 38.17±7.71（30～45） degree at the left side and 30.42±8.05（15～45） degree.Conclusions ①The right external iliac vein was firstly chosen for the establishment of the temporary vascular route in puncture of the external iliac vein,it is suggested that the direction of the needle tip should directed to the umbilicus and the inserting angle to the body surface should be 30～45 degree.It is suggested that the direction of the needle tip should be medially and upwardly 15～30 degree,and the inserting angle to the body surface should be 15～45 degree.② The manipulate of the hemodialysis in puncture of the external iliac vein is safe and simple,the volume of the blood flow is sufficient.This method may be used as a temporary substituting route for hemodialysis.