Department of Anesthesiology and Pain Medicine, Daegu Catholic University Medical Center, Daegu Catholic University School of Medicine, 33, Duryugongwon-ro 17-gil, Nam-gu, Daegu 42472, Republic of Korea.
Division of Vascular and Endovascular Surgery, Department of Surgery, Daegu Catholic University Medical Center, Daegu Catholic University School of Medicine, 33, Duryugongwon-ro 17-gil, Nam-gu, Daegu 42472, Republic of Korea.
Int J Environ Res Public Health. 2022 Nov 17;19(22):15158. doi: 10.3390/ijerph192215158.
Although brachial plexus block (BPB)-induced vasodilation reduces the incidence of arteriovenous access (AC) thrombosis, BPB cannot completely prevent its development. Therefore, we retrospectively investigated the factors affecting BPB-induced vasodilation and their effects on AC thrombosis development. Ninety-five patients undergoing AC surgery under BPB were analyzed. Vessel diameters were measured before and 20 min after BPB. The surgery abandoned before the BPB placement was performed when the BPB-induced increases in vessel diameters met its indications. Complete occlusive access thrombosis (COAT) was defined as loss of pulse, thrill, or bruit. Fourteen patients (14.7%) developed COAT. The outflow vein was more dilated by BPB than the inflow artery (0.6 versus 0.1 mm in median, < 0.001). The original surgery plan was changed for seven patients (7.4%). Diabetes mellitus (DM) and ischemic heart disease (IHD) decreased the extent of increases in the inflow artery by -0.183 mm (95% confidence interval [CI] [-0.301, -0.065], = 0.003) and outflow vein diameters by -0.402 mm (95% CI [-0.781, -0.024], = 0.038), respectively. However, DM, IHD, and changes in the vessel diameters had insignificant effects on the development of COAT. In conclusion, although DM and IHD attenuate the vasodilating effects of BPB, they do not contribute to the development of COAT.
尽管臂丛神经阻滞（BPB）引起的血管扩张可降低动静脉通路（AC）血栓形成的发生率，但 BPB 并不能完全预防其发生。因此，我们回顾性研究了影响 BPB 诱导血管扩张的因素及其对 AC 血栓形成发展的影响。分析了 95 例接受 AC 手术下 BPB 的患者。在 BPB 前和 BPB 后 20 分钟测量血管直径。当 BPB 诱导的血管直径增加符合其适应证时，在 BPB 放置前进行手术放弃。完全闭塞性通路血栓形成（COAT）定义为脉搏、震颤或杂音丧失。14 例患者（14.7%）发生 COAT。与入动脉相比，流出静脉通过 BPB 扩张更明显（中位数分别为 0.6 和 0.1 毫米，<0.001）。7 例患者（7.4%）改变了原始手术计划。糖尿病（DM）和缺血性心脏病（IHD）使入动脉直径的增加减少了 0.183 毫米（95%置信区间[CI] [-0.301，-0.065]， = 0.003），流出静脉直径减少了 0.402 毫米（95%CI [-0.781，-0.024]， = 0.038）。然而，DM、IHD 和血管直径的变化对 COAT 的发生没有显著影响。总之，尽管 DM 和 IHD 减弱了 BPB 的血管扩张作用，但它们与 COAT 的发生无关。
