肱动脉皮下转移建立透析血管通路的临床研究

Clinical study on establishing hemodialysis vascular access by subcutaneous transfer of the brachial artery

目的探讨肱动脉皮下转移建立永久性血液透析血管通路的应用前景。方法选取近9年该院行肱动脉皮下转移术建立血管通路20例作为观察组,均为行前臂动静脉内瘘失败或前臂静脉直径过小难以建立动静脉内瘘者,另选择20例已行动静脉内瘘后2个月的病例作为对照组;比较两组血管通路寿命、穿刺成功率及并发症的差异。结果两组的穿刺成功率、感染率、血液透析有效性等指标差异无显著性(P>0.05),观察组较对照组平均手术时间短、使用时间长(P<0.05),血流量不足、假性动脉瘤形成等并发症发生率相对较低(P<0.05),但易出血,血肿发生率高(P<0.05),且难以止血。结论肱动脉皮下转移后可作为血液透析永久性血管通路,其手术简单、易穿刺、血流量大、使用寿命长、不增加心脏负荷、无血液再循环现象,但穿刺具有一定的危险性,血肿发生率高,须严格掌握手术适应证及熟练掌握穿刺技术,尽量减少并发症的发生。

【Objective】 To discuss the application of established permanent hemodialysis vascular access by subcutaneous transfer of the brachial artery.【Methods】 20 cases who succeeded in establishing a permanent hemodialysis vascular access by subcutaneous transfer of the brachial artery in Wuzhou Worker＇s Hospital in the past nine years,were selected to observation group.They were either with an experience of failure in establishing forearm arteriovenous fistula or with a forearm vein diameter too small to establish the arteriovenous fistula.Control group included 20 cases who had established forearm arteriovenous fistula 2 months before.We compared vascular access life and success rate and complications of differences of the two groups.【Results】 The success rate,infection,and other indicators of the effectiveness of hemodialysis had no significant difference（P 0.05）,the observation group had shorter average operation time but longer vascular access life than the control group（P 0.05）,with relatively lower incidence of complications such as pseudoaneurysm,lack of blood flow（P 0.05）.However the observation group had a higher risk of bleeding and hematoma than the control group（P 0.05） when bleeding occur,it is difficult to stop.【Conclusions】 Subcutaneous transfer of the brachial artery can be used as an approach to establish permanent hemodialysis vascular access,as the operation is simple and easy to puncture with better blood flow and longer vascular access life without increasing heart load blood recirculation.However the risk of puncture and the high incidence of hematoma should be considered surgical indications and puncture technique should be strictly mastered to minimize complications.