围手术期预防及治疗人工血管动静脉瘘诱发的缺血

Perioperative prevention and treatment of arteriovenous graft induced distal ischemia

目的探讨围手术期预防及早期治疗人工血管动静脉瘘诱发的缺血的方法。方法回顾性分析上海中医药大学附属龙华医院血管外科行人工血管动静脉瘘患者围手术期预防及治疗缺血的治疗效果。结果 2017年1月～2018年4月行上肢人工血管动静脉瘘共129例,87例患者出现轻中度缺血症状,平均年龄(58.9±11.2)岁,平均透析时间(76.3±64.5)月;Ⅰ级缺血患者59例(67.8%),Ⅱa级缺血患者28例(32.2%),其中麻木27例,疼痛1例;术后即刻毛细血管充盈时间较术前延长[(3.69±0.45)s vs.(1.58±0.14)s,P<0.001],采取保暖措施、前列地尔扩血管治疗、罂粟碱解痉后,毛细血管充盈时间逐渐恢复,术后第5天毛细血管充盈时间较术前无统计学差异(P=0.172)。术前、术后即刻及术后第5天毛细血管充盈时间比较的单因素方差分析显示F=1588.274,P<0.001。结论患者行人工血管动静脉瘘术前全面评估,术中合理设计,术后予以保暖、扩血管、解痉治疗,能有效预防并降低术后缺血发生。

Objectives To discuss the early perioperative prevention and treatment of arteriovenous graft(AVG) induced ischemia. Methods The effect of perioperative prevention and treatment of AVG induced ischemia in Department of Vascular Surgery, Shanghai Longhua Hospital was retrospectively analyzed. Results From Jan. 2017 to Apr. 2018, upper limb AVG was performed in a total of 129 cases. Light or moderate hand ischemia was found in 87 cases, with the mean age of 58.9±11.2 yrs and mean dialysis period of 76.3±64.5 months; 59 cases(67.8%) had gradeⅠischemia, and 28 cases(32.2%, 27 cases with numb and one case with ache) had grade Ⅱ a ischemia. Capillary filling time immediately after the operation was significantly longer than that of preoperation(3.69±0.45 s vs. 1.58±0.14 s, P<0.001). After treatment of warm preservation,alprostadil and papaverine for spasmolysis and vascular dilatation, the symptoms of ischemia relieved. Capillary filling time after operation for 5 days and that of preoperation became no statistically different anymore(P=0.172). The comparison between capillary filling time before operation, immediately after operation and after operation for 5 days by one-way ANOVA showed a result of F=1588.274, P<0.001. Conclusions Comprehensive evaluation and carefully designing the operation before AVG and warm preservation and drugs for spasmolysis and vascular dilatation after AVG operation can effectively prevent and reduce the postoperative ischemia.