局部浸润麻醉在前臂自体动静脉内瘘狭窄腔内治疗中的临床应用

Clinical Application of Loca lnfiltration Anesthesia in the Endovascular Treatment of Forearm Autogenous Arteriovenous Fistula Stenosis

目的 总结局部浸润麻醉在前臂自体动静脉内瘘狭窄腔内治疗中的经验和体会。方法 选取前臂自体动静脉内瘘狭窄进行腔内治疗的患者42例,根据对前臂自体动静脉内瘘狭窄血管周围有无局部浸润麻醉分为对照组21例和局麻组21例,比较局部浸润麻醉在自体动静脉内瘘狭窄腔内治疗中的作用。结果 2组患者在入路穿刺前给予局部浸润麻醉时疼痛数字评分差异无统计学意义(P=0.688)。在进行球囊扩张时,对照组患者疼痛感觉剧烈,随球囊压力增加疼痛感觉增加,其中6例患者因不能耐受剧烈疼痛而未达到术前设定的扩张压力,而局麻组患者均能较好的耐受球囊扩张所引发的疼痛,全部达到预定扩张压力。2组患者在对狭窄血管进行球囊扩张时疼痛数字评分差异明显,具有统计学意义(P<0.01)。结论 对于自体动静脉内瘘存在狭窄的患者而言,预先在狭窄血管周围行局部浸润麻醉后再进行球囊扩张能够明显减轻手术疼痛,有效地保证了手术效果。

To summarize the treatment experience of local infiltration anesthesia in the endovascular treat-ment of forearm autologous arteriovenous fistula stenosis.Methods Thirty-three patients patients with fore-arm autogenous arteriovenous fistula stenosis treated by endovascular surgery were selected.All patients were divided into control group(21 patients)and local anesthesia group(21 patients)according to whether there was local infiltration around the stenosis of forearm arteriovenous fistula.The role of local infiltration anesthesia in endovascular treatment of autologous arteriovenous fistula stenosis was summarized.Results There was no significant difference in pain numerical scores between the two groups when received local in-filtration anesthesia before puncture(P=0.688).Patients in the control group experienced severe pain during balloon dilatation,which increased as balloon pressure increased.Six of them were unable to tolerate severe pain and didn’t reach the predetermined dilatation pressure,whereas the patients in the local anesthesia group were able to tolerate the pain caused by balloon dilatation and all reached the predetermined expan-sion pressure.During balloon dilatation of stenotic vessels,there was a significant difference in pain numer-ical scores between the two groups(P<0.01).Conclusion For patients with autogenous arteriovenous fistula stenosis,local infiltration anesthesia around the stenosis vessels before balloon dilatation can significantly alleviate the pain of the operation and effectively ensure the surgical effect.