实用医学杂志 ›› 2025, Vol. 41 ›› Issue (9): 1293-1298.doi: 10.3969/j.issn.1006-5725.2025.09.004

• 专题报道:肾病 • 上一篇    

超声引导下肌间沟与腋路臂丛神经阻滞对终末期肾病患者动静脉内瘘成形术通畅率的影响

张弛1,李筱1,魏祥1,陈刚毅2,李红梅3,王可佳3,郑俊奕3()   

  1. 1.广州中医药大学第一临床医学院 (广东 广州 510405 )
    2.广州中医药大学第一附属医院 肾病科 (广东 广州 510405 )
    3.广州中医药大学第一附属医院 麻醉科 (广东 广州 510405 )
  • 收稿日期:2025-03-06 出版日期:2025-05-10 发布日期:2025-05-20
  • 通讯作者: 郑俊奕 E-mail:zhengjunyi1977@163.com
  • 基金资助:
    广东省哲学社会科学规划项目(GD22CGL36)

Impact of ultrasound guided interscalene versus axillary brachial plexus block on patency rate of arteriovenous fistula

Chi ZHANG1,Xiao LI1,Xiang WEI1,Gangyi CHEN2,Hongmei LI3,Kejia WANG3,Junyi ZHENG3()   

  1. The First Clinical Medical School of Guangzhou University of Chinese Medicine,Guangzhou 510405,Guangdong,China
  • Received:2025-03-06 Online:2025-05-10 Published:2025-05-20
  • Contact: Junyi ZHENG E-mail:zhengjunyi1977@163.com

摘要:

目的 与局部麻醉对比,探讨不同入路臂丛神经阻滞对终末期肾病(ESRD)患者首次接受桡动脉-头静脉内瘘(RCAVF)手术的安全性与有效性。 方法 将ESRD患者随机分为三组:局部麻醉(LA)组、肌间沟入路臂丛神经阻滞(ISBPB)组和腋路臂丛神经阻滞(ABPB)组。超声测量麻醉前后靶血管的直径和血流变化量。术后在3 d和3个月进行随访,以评估瘘管通畅情况。 结果 术后即时通畅率分别为:LA组92.52%,ISBPB组96.26%,ABPB组95.33%,三组之间差异无统计学意义(χ 2 = 1.615,P = 0.446)。术后3个月三组患者的初级通畅率差异有统计学意义(χ 2 = 22.691,P < 0.001),ISBPB组(83.18%)显著高于LA组(57.01%)(χ 2 = 17.477,P < 0.001),ABPB组(80.37%)显著高于LA组(χ 2 = 13.580,P < 0.001),ISBPB组呼吸功能受影响的患者(15.89%)显著高于LA组(2.80%)(χ 2 = 9.761, P = 0.002)与ABPB组(0.93%)(χ 2 = 14.377, P < 0.001);LA组与ABPB组差异无统计学意义(χ 2 = 1.019, P = 0.313)。 结论 在初次创设AVF时,ISBPB和ABPB比局部麻醉更有效。而ABPB对ESRD患者生理状态的影响较小,且提供了更加舒适的手术体验。

关键词: 动静脉内瘘, 终末期肾病, 肌间沟入路臂丛神经阻滞, 腋路臂丛神经阻滞

Abstract:

Objective To compare the safety and efficacy of various brachial plexus block techniques using local anesthesia (LA) in patients undergoing their first radiocephalic arteriovenous fistula (RCAVF) surgery. Methods Patients were randomly allocated into three groups: LA, interscalene brachial plexus block (ISBPB), and axillary brachial plexus block (ABPB). Ultrasound was utilized to evaluate the pre- and post-anesthesia changes in vessel diameter and blood flow. Postoperative follow-up assessments were performed at three days and three months to determine fistula patency. Results Immediate patency rates were 92.52% (LA), 96.26% (ISBPB), and 95.33% (ABPB), with no statistically significant differences among the groups (χ2 = 1.615, P = 0.446). However, at three months, primary patency rates differed significantly among the groups (χ2 = 22.691, P < 0.001). Specifically, the ISBPB group (83.18%) exhibited significantly higher patency compared to the LA group (57.01%) (χ2 = 17.477, P < 0.001). Similarly, the ABPB group (80.37%) demonstrated better patency than the LA group (χ2 = 13.580, P < 0.001). Regarding respiratory complications, they were more prevalent in the ISBPB group (15.89%) compared to the LA group (2.80%) (χ2 = 9.761, P = 0.002) and the ABPB group (0.93%) (χ2 = 14.377, P < 0.001). No significant difference was observed between the LA and ABPB groups in terms of respiratory complications (χ2 = 1.019, P = 0.313). Conclusions Both ISBPB and ABPB demonstrated superior primary patency compared to LA. Nevertheless, ABPB exerted a lesser impact on respiratory function and provided a more comfortable surgical experience for ESRD patients.

Key words: autogenous arteriovenous fistula, end-stage renal disease, interscalene brachial plexus block, axillary brachial plexus block

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