桡动脉获取技术及对前臂影响的探讨

目的　探讨桡动脉获取技术和桡动脉获取后对前臂供血、供氧和功能的影响。　方法　1998年9月～2000年4月用桡动脉做为移植材料行冠状动脉旁路移植术50例。桡动脉的获取标准采用改良Allen′s实验、量化Allen′s实验、术前超声检查和术中Allen′s实验判定桡动脉功能及尺动脉代偿功能;采用不接触血管技术获取桡动脉。　结果　桡动脉长14～22cm，桡动脉口径近端（2.89±0.38）?mm,远端（2.76±0.36）?mm，通畅情况良好。手术后前臂无血肿形成，活动良好。无与桡动脉桥有关的心脏并发症。2例桡动脉内膜轻度增生，其余病例桡动脉均正常。术后前臂血流图检查，术侧波幅为0.053±0.009，对侧为0.054±0.017；术侧尺动脉血流速度为（26.38±4.09）cm/s，对侧为（18.82±6.11）?cm/s；术侧尺动脉血流量术前为（30.78±9.71）?ml/min，手术后为（43.36±13.98）?ml/min，差异均有显著性意义（P＞0.05）；左、右手无创血氧饱和度及同一手手术前后的血氧饱和度均差异无显著性意义（P＞0.05）。术侧前臂旋前、旋后及腕关节屈、伸的肌力均正常（Ⅴ级），但较健侧肌力略差。少数患者大鱼际和第1、2掌骨间背侧皮肤麻木，桡神经运动支和正中神经传导速度正常，两侧差异无显著性意义（P＞0.05）。　结论　采用不接触血管技术获取桡动脉，可避免桡动脉、周围血管和神经损伤；严格掌握桡动脉的获取标准，桡动脉取出后对前臂功能基本无影响。术后术侧前臂供血有所减少，但不影响前臂供氧。

Technique for harvesting the radial artery and its effect on the forearm

Objective To study the technique of harvesting radial artery (RA)and its effect on the forearms.Methods The RA as a conduit for coronary artery bypass surgery was used in 50 patients (41 men and 9 women). Their average age was 61 years (42-75 years). The standards for harvesting the radial artery included modified Allen′s test,quantified Allen′s test, preoperative ultrasound examination, and intraoperative Allen′s test.We used “non-touch” technique to harvest the radial artery. Results The length of the artery was 14-22 cm, its diameter was (2.89±0.38) mm at the proximal end and (2.76±0.36) mm at the distal end. The inner of artery was gentle hyperplasia in 2 patients, and normal in the rest. No postoperative hematomas were observed in the forearms, nor radial artery grafts related cardiac complications.The blood flow rate of forearm in the operated side was lower than in the other side, and the blood flow speed of ulnar artery was (26.38±4.09) cm/s in the operative side and (18.82±6.11) cm/s in the other side(P＜0.05). The blood flow rate of the ulnar artery was (30.78±9.71) ml/min preoperatively and (43.36±13.98) ml/min postoperatively(P＜0.05). No difference in SaO2 was seen between two hands postoperatively, nor in SaO2 between preoperative and postoperative measurement on the redial artery hand. The power of concentric extensors, flexors, supinators, and pronators in the operative side was normal,but it was weaker than in the other side. Few patients felt unmbness between the first and second metacarpal bone.The conduct speed of the radial nerve and median nerve was normal. Conclusions With the non-touch technique to harvest the radial artery, the injury to the radial artery and surrounding nerves can be avoided. As long as the standards for radial artery harvesting are strictly followed, the function of forearm and oxygen supply are not affected after radial artery harvesting.