手术干预前后自体动静脉内瘘动脉瘤的临床观察

Clinical observation on Pre-and post-operative clinical status of surgery for autogenous arteriovenous fistula aneurysm

目的观察维持性血液透析患者动-静脉内瘘并发动脉瘤及内瘘高血流量时,采取外科手术治疗的疗效及手术前后动静脉内瘘血流量、心博出量的变化。方法选取动静脉内瘘并发动脉瘤同时内瘘血流量较高的患者24例,给予术前检查内瘘血管超声,测量内瘘直径,瘘口静脉端横截面积,血流量,心脏超声,计算心搏指数及血浆脑钠肽测定,次日行外科手术治疗,术后次日、3 d、1月再次检查上述指标,并与术前进行比较。外科手术方法包括动脉瘤体短路法、瘤体切除加静脉连续缝合法。结果 24例患者均顺利完成手术,术后内瘘通畅率100%,术后动静脉内瘘内径较前缩短,横截面积缩小,血流量减低,心搏量下降,心脏各腔室内径缩小。术后1年无明显并发症。结论动静脉内瘘并发动脉瘤,伴内瘘血流量增高时,及时行手术治疗,不但可以避免瘤体破溃等严重并发症,而且可以通过手术缩窄瘘口,减轻心脏前负荷,降低心搏指数。

Objective To evaluate the effect of surgery treatment for aneurysm with high flow rate of autogenous arteriovenous fistula compare pre-and post-operative fistula flow rate and cardiac output.Methods Twenty-four patients with aneurysm and high flow rate of autogenous arteriovenous fistula were recruited and underwent surgery treatment. Pre-and post-operative fistula vessel diameter,venous cross-sectional area and blood flow rate were measured by vessel ultrasound. Stroke volume index calculated using echocardiography and brain natriuretic peptide were also determined before and after the surgery.Results Surgeries for all the patients were successfully completed and post-operative fistula patency was 100%.Compared with corresponding pre-operative indices,there were significant reductions of fistula vessel diameter,venous cross-sectional area,blood flow rate,cardiac stroke volume and diameters of cardiac chambers after the surgery. There were no obvious complications one year after the surgery. Conclusions Surgery treatment for aneurysm with high flow rate of autogenous arteriovenous fistula is effective in reducing fistula vessel diameter as well as lowering cardiac pre-load and stroke volume without any severely complications.