【摘要】：目的通過比較去抗原同種異體大隱靜脈和人工血管兩種移植血管材料建立的長期血液透析血管通路的臨床應(yīng)用效果,探討去抗原同種異體大隱靜脈作為移植血管材料的可行性、有效性和安全性,為血管耗竭不能建立自體動靜脈內(nèi)瘺(AVF)的終末期腎病(ESRD)患者尋找一種有效的移植血管材料。方法采用簡單隨機(jī)抽樣的方法,將2015年5月至2016年12月間在濟(jì)南市中心醫(yī)院血液凈化中心采用移植血管建立長期血管通路的患者分為兩組:A組去抗原同種異體大隱靜脈組12例,B組人工血管(聚四氟乙烯、PTFE)組12例,隨訪3個月至18個月,從以下幾個方面觀察去抗原同種異體大隱靜脈組(A組)和聚四氟乙烯移植血管組(B組):術(shù)后出現(xiàn)疼痛、腫脹、麻木等不適癥狀的情況,透析充分性(Kt/V),并發(fā)癥發(fā)生前血液透析血流量、穿刺止血時間、通暢率(3個月、6個月、9個月、12個月,15個月、18個月),狹窄、栓塞、感染、血管瘤樣擴(kuò)張、肢體遠(yuǎn)端缺血征、腫脹手綜合征等并發(fā)癥的發(fā)生率以及發(fā)生狹窄后移植血管組織形態(tài)學(xué)觀察(HE染色、CTGF、TGF-β1的表達(dá)情況)。采用EXCEL進(jìn)行數(shù)據(jù)錄入,使用SPSS19.0軟件進(jìn)行統(tǒng)計分析。計數(shù)資料比較采用Fisher檢驗,符合正態(tài)分布的計量資料用均數(shù)±標(biāo)準(zhǔn)差表示,組間比較采用t檢驗,以P0.05為有統(tǒng)計學(xué)意義。結(jié)果兩組患者的年齡和原發(fā)疾病構(gòu)成,統(tǒng)計學(xué)無明顯差異(P0.05);A組患者中,有4例患者術(shù)后感疼痛,可耐受,1例患者手術(shù)側(cè)肢體腫脹,無患者肢體麻木;B組患者中,有6例患者術(shù)后感疼痛,其中4例患者藥物止痛,4例患者術(shù)側(cè)肢體腫脹,2例患者術(shù)側(cè)肢體輕度麻木;在隨訪期間,A組和B組兩組患者透析時的Kt/V值都1.4(P0.05);A、B組患者的透析血流量均大于200ml/min,血流量穩(wěn)定,無血流量不足者(P0.05);A組比B組患者透析結(jié)束時穿刺止血時間短,t'=-2.271(P0.05);A組術(shù)后3個月、6個月、9個月、12個月、15個月及18個月的通暢率較B組均高;A組患者感染的發(fā)病率較B組低(P0.01);兩組狹窄、栓塞、血管瘤樣擴(kuò)張、肢體遠(yuǎn)端缺血征、腫脹手綜合征發(fā)病率的比較無顯著統(tǒng)計學(xué)意義(P0.05);A組與B組患者中出現(xiàn)狹窄并發(fā)癥后的移植血管標(biāo)本,HE染色觀察,內(nèi)膜明顯增厚,可見明顯平滑肌細(xì)胞增生,CTGF主要在血管內(nèi)膜及外膜處表達(dá),呈棕黃色,TGF-β1在血管內(nèi)膜、中膜、外膜均表達(dá),呈棕黃色;。結(jié)論1、經(jīng)去抗原同種異體大隱靜脈移植血管內(nèi)瘺透析的患者能達(dá)到充分的透析效果,血流量穩(wěn)定,止血時間短,感染的發(fā)生率較低2、導(dǎo)致移植血管內(nèi)瘺狹窄主要是內(nèi)膜增生,內(nèi)皮細(xì)胞與平滑肌纖維細(xì)胞是增生的主要成分,特別是平滑肌纖維成分的增生。3、當(dāng)自體動靜脈內(nèi)瘺無法建立時,去抗原同種異體大隱靜脈可作為一種較好的移植血管材料應(yīng)用在臨床。
[Abstract]:Objective to compare the clinical effect of long-term hemodialytic vascular pathway established by antigenic great saphenous vein and artificial blood vessel transplantation materials, and to explore the feasibility, effectiveness and safety of antigen-free great saphenous vein as vascular graft material, and to find an effective vascular graft material for (ESRD) patients with end-stage kidney disease whose vascular depletion can not establish autologous arteriovenous fistula (AVF). Methods A simple random sampling method was used to establish a long-term vascular pathway in the blood purification center of Jinan Central Hospital from May 2015 to December 2016. there were 12 patients in group A and 12 patients in group B (polytetrafluoroethylene, PTFE) group). The patients were followed up for 3 months to 18 months. The symptoms of pain, swelling and numbness, dialysis adequacy (Kt/V), blood flow before complications, puncture hemostasis time, patency rate (3 months, 6 months, 9 months, 12 months, 15 months, 18 months), stenosis, embolism and infection were observed from the following aspects: antigenic great saphenous vein group (group A) and polytetrafluoroethylene transplantation group (group B), such as pain, swelling, numbness and other uncomfortable symptoms, dialysis adequacy (HD), blood flow before complications, puncture hemostasis time, patency rate (3 months, 6 months, 9 months, 12 months, 15 months, 18 months). The incidence of complications such as angiomatoid dilatation, distal limb ischemic sign, swelling hand syndrome and histomorphology (HE staining, expression of CTGF,TGF- 尾 1) after stenosis. EXCEL is used for data input and SPSS19.0 software is used for statistical analysis. The counting data were compared by Fisher test, the measurement data in accordance with normal distribution were expressed by mean 鹵standard deviation, and the comparison between groups was carried out by t test, and P 0.05 was statistically significant. Results there was no significant difference in age and primary disease composition between the two groups (P 0.05); A group, 4 patients had postoperative pain and tolerable pain, 1 patient had limb swelling and no limb numbness, 6 patients in group B had postoperative pain, 4 patients had drug analgesia, 4 patients had postoperative limb swelling, 2 patients had mild numbness), 4 patients had postoperative pain, 4 patients had postoperative limb swelling, and 2 patients had mild numbness. During the follow-up period, the Kt/ V values of group A and group B were both 1.4 (P 0.05), A, the blood flow of group B was more than 200ml / min, the blood flow was stable, and there was no insufficient blood flow (P < 0.05). The time of puncture hemostasis at the end of dialysis in group); A was shorter than that in group B (P < 0.05). The patency rate of group A was higher than that of group B at 3 months, 6 months, 9 months, 12 months, 15 months and 18 months after operation. The incidence of infection in group A was lower than that in group B (P 0.01). There was no significant difference in the incidence of stenosis, embolism, angiomatoid dilatation, distal limb ischemia and swollen hand syndrome between the two groups (P 0.05). In group A and group B, the intima were obviously thickened and smooth muscle cells proliferated. CTGF was mainly expressed in intima and adventitia, and TGF- 尾 1 was expressed in intima, media and adventitia, which was brown and yellow in group A and group B. the expression of VEGF 尾 1 in intima, media and adventitia was brown and yellow, and the expression of VEGF 尾 1 in intima, media and adventitia was brown and yellow, respectively. Conclusion 1. The patients with endovascular fistula treated with antigenic great saphenous vein transplantation can achieve sufficient dialysis effect, the blood flow is stable, the hemostatic time is short, the incidence of infection is low 2, resulting in intimal hyperplasia, endothelial cells and smooth muscle fiber cells are the main components of proliferation, especially the proliferation of smooth muscle fibers. 3, when autologous arteriovenous fistula can not be established, Antigenic allogenic great saphenous vein can be used as a good vascular graft material in clinic.
【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R459.5

【相似文獻(xiàn)】

相關(guān)期刊論文 前10條

1 張強(qiáng)，，段志泉;阻抗分析與血管掃描用于診斷移植血管狹窄[J];中國普通外科雜志;1995年04期

2 陳緒軍;陳鑫;石開虎;徐明;汪黎明;;冠狀動脈旁路移植術(shù)后移植血管狹窄的危險因素分析[J];中國胸心血管外科臨床雜志;2008年06期

3 李蕓;門脈減壓——應(yīng)用H型移植血管的臨床經(jīng)驗[J];國外醫(yī)學(xué)參考資料.外科學(xué)分冊;1975年02期

4 陳燕,張強(qiáng),段志泉;血管多普勒掃描對移植血管狹窄的診斷價值[J];中國醫(yī)科大學(xué)學(xué)報;1998年06期

5 連鋒;冠狀動脈旁路移植術(shù)后移植血管狹窄的治療研究進(jìn)展[J];醫(yī)學(xué)綜述;1999年10期

6 王敏敏;冠脈旁路移植手術(shù)移植血管的選擇[J];心血管病學(xué)進(jìn)展;2002年01期

7 馬小靜 ,任書堂 ,葉蓉 ,胡麗華 ,陶涼 ,尚玉強(qiáng);多普勒超聲在冠狀動脈旁路移植術(shù)中移植血管檢測的初步研究[J];中華超聲影像學(xué)雜志;2002年11期

8 董士勇;李一帆;宋波;杜迎利;肖鋒;李巖;;非體外循環(huán)冠狀動脈旁路移植術(shù)圍手術(shù)期心肌梗死發(fā)生率與移植血管血流量的關(guān)系[J];中國胸心血管外科臨床雜志;2011年06期

9 張大維;;冠狀動脈旁路手術(shù)后開始服用阿司匹林對移植血管早期開放的影響[J];國外醫(yī)學(xué).心血管疾病分冊;1992年04期

10 吳忠均,朱毅,時德,鄭樹森,李德衛(wèi);轉(zhuǎn)染血小板源生長因子和增殖細(xì)胞核抗原反義寡核苷酸抑制移植血管狹窄的實驗研究[J];中華外科雜志;2005年07期

相關(guān)會議論文 前2條

1 陳鑫;徐明;邱志兵;蔣英碩;繆勁;郭子璜;肖立瓊;;再次冠狀動脈旁路移植術(shù)12例治療體會[A];第八屆華東六省一市胸心血管外科學(xué)術(shù)會議論文匯編[C];2005年

2 傅先水;王金銳;唐杰;曹海根;李俊來;羅渝昆;徐建宏;;超聲對橈動脈作為移植血管橋的術(shù)前篩選和術(shù)后評估:附30例患者及150例志愿者尺-橈動脈間側(cè)支循環(huán)模式資料[A];中華醫(yī)學(xué)會超聲醫(yī)學(xué)新進(jìn)展學(xué)術(shù)會議論文匯編[C];2004年

相關(guān)重要報紙文章 前3條

1 記者 宜秀萍;省醫(yī)完成全省首例移植血管瘺成形術(shù)[N];甘肅日報;2012年

2 記者 王耀;全省首例移植血管瘺成形術(shù)完成[N];甘肅經(jīng)濟(jì)日報;2012年

3 記者 劉曉芳;甘肅首例移植血管瘺成形術(shù)完成[N];蘭州日報;2012年

相關(guān)博士學(xué)位論文 前2條

1 王齊敏;內(nèi)皮素受體A反義寡聚核苷酸抑制大鼠移植血管內(nèi)膜增殖的作用[D];福建醫(yī)科大學(xué);2004年

2 陸現(xiàn)碩;炎癥因子及外膜炎癥反應(yīng)與移植血管動脈硬化早期發(fā)病關(guān)系的實驗研究[D];山東大學(xué);2007年

相關(guān)碩士學(xué)位論文 前4條

1 白雪;去抗原同種異體大隱靜脈移至內(nèi)瘺的臨床應(yīng)用效果[D];山東大學(xué);2017年

2 成偉;冠狀動脈旁路移植術(shù)后中遠(yuǎn)期效果的隨訪研究及影響因素分析[D];山東大學(xué);2009年

3 高進(jìn);利用兔頸動脈旁路移植模型評價新型全生物化小口徑移植血管[D];山西醫(yī)科大學(xué);2011年

4 徐俊文;SM22α和KDR啟動子/增強(qiáng)子基因調(diào)控PI3K信號通路對移植血管新生內(nèi)膜增生的影響[D];山西醫(yī)科大學(xué);2011年

本文編號：2498791