【摘要】目的探索构建CO2气体输送系统并联合全自动高压注射系统在血液透析动静脉通路(arteriovenous access，AVA)CO2造影的运用。方法用飞利浦Allura Xper FD10 数字剪影血管造影机，将医用无菌塑料袋CO2气体输送系统连接Medrad Mark V ProVis 自动高压注射系统，对33 例尿毒症患者AVA 进行血管造影术，对可获得清晰血管影像时CO2使用剂量、注射速度、摄像频率、副反应等技术参数进行观察和记录。结果33 例患者安全完成既定198 次造影检查，31 例患者执行了腔内治疗，2 例完成开放手术治疗；AVA 常见外周血管使用CO2 5～20ml/次，速度5～10ml/s；中心静脉60～80ml/次，速度25～30ml/s 可以获得清晰影像；仅1 例患者造影部位出现疼痛数字评价量表(numeric rating scale，NRS)6级疼痛，其余患者无任何不良反应。结论本研究所构建CO2塑料袋气体输送系统简便安全，结合全自动高压注射系统可以自动精准注射CO2，减少医护人员射线暴露，对有残余肾功能和碘剂过敏AVA 患者提供
了安全可靠的血管造影手段，可以推广。
【Abstract】Objective To explore the application of the CO2 gas delivery system combined with automatic high-pressure injection system for the imaging of arteriovenous access (AVA) for hemodialysis. Methods A total of 33 uremic patients were subjected to angiography using the Philips Allura Xper FD10 digital subtraction angiographer. A self-built CO2 gas delivery system using a sterile medical plastic bag was connected to the Medrad Mark V ProVis automatic high-pressure injection system. The CO2 volume, injection speed, camera frequency, side effects and other technical parameters were recorded when clear vascular images of
the target parts were obtained. Results A total of 198 angiographic examinations were conducted safely in the 33 patients, in which 31 patients finished the planned intravascular manipulation, and 2 patients had open surgery. To obtain clear images, CO2 5～20 ml/time with the speed of 5～10 ml/sec were used forAVAperipheral vessel imaging and CO2 60～80 ml/time with the speed of 25～30 ml/sec were used for central vein imaging. No untoward reactions were found, except pain of grade 6 by numeric rating scale at the imaging site in one case. Conclusion It is simple and safe to make aCO2 delivery system using a sterile plastic bag in this study. Combined with the automatic high-pressure injection system, CO2 can be injected accurately and automatically, reducing the radiation exposure of medical staff and providing a safe and reliable angiographic method for patients with residual
renal function and allergic to iodine. This system can be widely used clinically.
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