摘要
目的：探讨因上肢血管耗竭不能建立血管通路的尿毒症患者,通过建立股部人工血管移植动静脉内瘘术行血液透析的必要性. 方法：2011年7月至2014年3月15例尿毒症维持性血液透析患者行右侧股部股（浅）动脉-大隐静脉人工血管移植内瘘术,对手术方式及效果进行评价. 结果：15例患者手术均成功且无并发症,术后内瘘通畅,血液透析时血流量＞230 ml/min.所有患者随访3～34月,除1例患者术后半年出现血栓形成,取栓成功,半年后再次堵塞取栓失败后改留置右侧颈内静脉半永久导管维持透析.1例血清肿形成大半年后行手术清除,未影响内瘘使用.应用多重线性回归分析结果显示,超滤率、收缩压、血磷、总胆固醇、三酰甘油是内瘘血栓形成独立影响因素,差异有统计学意义. 结论：对上肢血管条件无法行人工血管移植的尿毒症患者,选择股部人工血管移植作为新的血管通路,是有效实用的方法.减少超滤率、预防透析低血压、控制高黏滞血症及高磷血症可减少内瘘血栓形成.
Objective： To investigate the upper limb vessels in patients with uremia exhaustion when vascular access can not be established, the method and necessity of establishing arteriovenous fistulations with artificial vessel transplantation in the thigh for hemodialysis. Methodology： July 2011 to March 2014 15 uremic hemodialysis patients enrolled undergraduate room, on the right thigh establishing bypass graft fistula with artificial vessel in the shares （shallow） artery-saphenous vein, surgical approach summary evaluation and use of effects. Results： 15 patients were operated successfully without complications, the use of postoperative fistula patency, bemodialysis blood flow amounted to 230 ml/min or more. Followed up for 3 ~ 34 months, one patient thrombosis occurs after six months, successful embolectomy, thrombectomy again and failed to change after six months, at last indwelling half permanent catherter to hemodialysis. One case of seroma formation over six months underwent surgical removal, but does not affect the use of the fistula. Multiple linear regression analysis ： the UF rates. Systolic Pressure. Serum Phosphorus. CHOL and TG were the independent risk factors for thrombosis occurs, the differences was statically significant（ P〈0.05 ）. Conclusion： Patients with upper extremity vascular conditions uremic not artificial vascular grafts, artificial vascular graft choice femoral vascular access for a new way that is effective and practical method. Reduce UF rates, avoid hypotension, control of blood hyperviscosity syndrome and hyperphosphatemia can decrease the thrombosis occurs of fistula.
出处
《肾脏病与透析肾移植杂志》
CAS
CSCD
北大核心
2014年第5期443-446,共4页
Chinese Journal of Nephrology,Dialysis & Transplantation
关键词
尿毒症患者
股部
人工血管移植动静脉内瘘术
血液透析
uremic patients thigh arteriovenous fistulations with artificial vessel transplantation hemodialysis
