通络活血沐手方治疗血液透析患者动静脉内瘘成熟不良的临床效果
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摘要
目的探讨通络活血沐手方治疗血液透析患者动静脉内瘘成熟不良的临床效果。方法选取2016年10月～2018年10月广东省中医院收治的行动静脉内瘘手术后内瘘成熟不良的患者60例为研究对象,采用随机数字表法将其分为对照组(30例)和研究组(30例)。对照组患者采用温水沐手,研究组采用通络活血沐手方治疗。比较两组患者不同时间点内瘘指标、血液透析中泵控血流量、动静脉内瘘成熟时间,观察两组患者治疗期间不良反应发生情况。结果研究组治疗4周后每分钟血流量、静脉血管内径、血管壁厚度高于对照组(P <0.05)。研究组血液透析中泵控血流量多于对照组,动静脉内瘘成熟时间短于对照组(P <0.05)。两组患者不良反应发生率比较差异无统计学意义(P> 0.05)。结论通络活血沐手方可有效促进血液透析患者动静脉内瘘成熟,缩短动静脉内瘘成熟时间,且不增加不良反应发生率,具有一定的临床应用价值。
Objective To explore the clinical efficacy of Tongluo Huoxue Mushou Prescription in the treatment of poor maturity of arteriovenous fistula in hemodialysis patients. Methods From October 2016 to October 2018, 60 patients with poor maturity of internal fistula after arteriovenous fistula operation admitted to Guangdong Hospital of Traditional Chinese Medicine were selected as research objects. The patients were divided into control group(30 cases) and study group(30 cases) by random number table method. The control group was treated with warm water and the research group was treated with Tongluo Huoxue Mushu Prescription. The internal fistula index at different time points, pump controlled blood flow in hemodialysis and maturity time of arteriovenous fistula were compared between the two groups,and the adverse reactions of the two groups during treatment were observed. Results After 4 weeks of treatment, the blood flow per minute, the diameter of vein and the thickness of vessel wall in the study group were higher than those in the control group(P < 0.05). Pump-controlled blood flow in the study group was more than that in the control group,and the maturation time of arteriovenous fistula in the study group was shorter than that in the control group(P < 0.05).There was no significant difference in the incidence of adverse reactions between the two groups(P > 0.05). Conclusion Tongluo Huoxue Mushou Prescription can effectively promote the maturation of arteriovenous fistula in hemodialysis patients, shorten the maturation time of arteriovenous fistula without increasing the incidence of adverse reactions,and has certain clinical application value.
Objective To explore the clinical efficacy of Tongluo Huoxue Mushou Prescription in the treatment of poor maturity of arteriovenous fistula in hemodialysis patients. Methods From October 2016 to October 2018, 60 patients with poor maturity of internal fistula after arteriovenous fistula operation admitted to Guangdong Hospital of Traditional Chinese Medicine were selected as research objects. The patients were divided into control group(30 cases) and study group(30 cases) by random number table method. The control group was treated with warm water and the research group was treated with Tongluo Huoxue Mushu Prescription. The internal fistula index at different time points, pump controlled blood flow in hemodialysis and maturity time of arteriovenous fistula were compared between the two groups,and the adverse reactions of the two groups during treatment were observed. Results After 4 weeks of treatment, the blood flow per minute, the diameter of vein and the thickness of vessel wall in the study group were higher than those in the control group(P < 0.05). Pump-controlled blood flow in the study group was more than that in the control group,and the maturation time of arteriovenous fistula in the study group was shorter than that in the control group(P < 0.05).There was no significant difference in the incidence of adverse reactions between the two groups(P > 0.05). Conclusion Tongluo Huoxue Mushou Prescription can effectively promote the maturation of arteriovenous fistula in hemodialysis patients, shorten the maturation time of arteriovenous fistula without increasing the incidence of adverse reactions,and has certain clinical application value.
引文
[1]陈林,曹晓翼,石梅,等.两种穿刺法在血液透析动静脉内瘘中的应用[J].护理研究,2016,30(8):967-969.
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[4]李春,吕路,重辉,等.血液透析留置针在自体动静脉内瘘中的应用及效果观察[J].护士进修杂志,2018,33(3):254-256.
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[8]侯海晶,王冠苏,蔡佑青,等.中药熏洗联合艾灸治疗对动静脉内瘘早期失功的保护作用[J].安徽中医药大学学报,2017,36(4):56-59.
[9]毛俐婵,王文荣,蒋贤辉,等.中药熏洗联合穴位注射对自体动静脉内瘘成熟影响的临床研究[J].浙江中西医结合杂志,2018,28(5):384-386.
[10]王晓菁,陈海平.慢性肾脏病定义及分期系统修订的进展———2012-KDIGO慢性肾脏病临床管理实践指南解读[J].中华老年多器官疾病杂志,2014,12(5):396-400.
[11] Polimanti AC,de Carvalho Fürst RV,Galego SJ,et al.Influence of intraoperative findings on immediate flow through radial-cephalic arteriovenous wrist fistulas for hemodialysis access[J]. J Vasc Bras,2018,17(3):208-214.
[12]路凌,张兰梅,武军,等.健脾补肾方对脾肾气虚型慢性肾功能衰竭血液透析患者营养状况的影响[J].国际中医中药杂志,2014,36(8):695-698.
[13] Fukasawa M,Isobe M,Nanto S,et al. NF-κB Decoy Oligodeoxynucleotide-Coated Balloon Catheter for Arteriovenous Fistula in Hemodialysis[J]. Kidney Int Rep,2018,4(1):126-138.
[14]陈松,李晓颖,于黔,等.尿毒症血液透析患者动静脉内瘘狭窄超声引导下PTA术后的疗效观察[J].中国超声医学杂志,2018,34(4):342-346.
[15]王建爽,杨文艳,李令娟,等.超声引导尿激酶溶栓治疗维持性血液透析患者动静脉内瘘的临床观察[J].中国医学装备,2016,13(4):78-81.
[16] Saleh MA,El Kilany WM,Keddis VW,et al. Effect of high flow arteriovenous fistula on cardiac function in hemodialysis patients[J]. Egypt Heart J,2018,70(4):337-341.
[17]王立华,姜埃利,魏芳,等.老年动静脉内瘘与长期置管血液透析患者的生存分析[J].中国老年学杂志,2016,36(7):1678-1681.
[18] Cortesi C,Duque JC,Mai S,et al. Assessment of left ventricular mass changes after arteriovenous fistula surgical banding in end-stage renal disease[J]. Saudi J Kidney Dis Transpl,2018,29(6):1280-1289.
[19]陈丽兰,伊娜,李慧枝,等.穴位注射联合中药熏洗治疗糖尿病下肢周围神经病变40例[J].广东医学,2013,34(10):1615-1617.
[20]王宇彤,李莉.益气活血通络法治疗急性心肌梗死介入术后患者43例[J].西部中医药,2017,30(6):68-71.
[21]莫贝霞.中药熏洗联合木瓜酒湿敷对促进动静脉内瘘成熟的应用[J].中国医药科学,2017,7(13):40-43.
[22]廖若夷,张晓,张月娟,等.中药熏洗治疗脑梗死痉挛性瘫痪的效果[J].中国康复理论与实践,2018,24(1):112-115.
[23]张伟,宋世锋,张丕军,等.通络活血方熏洗联合关节松动术治疗骨折后关节僵硬患者的临床疗效及对负面情绪的影响[J].陕西中医,2016,37(4):452-453.
[24]李道睿,王苗苗,于明薇,等.通络活血虫类药对乏氧环境下肺癌血管生成相关细胞因子的影响[J].中国中医药信息杂志,2017,24(9):39-42.
[25]张建英,谭志雄,罗雪琴,等.分析全面护理加红椒通络汤改善血透患者动静脉内瘘功能的临床研究[J].中国医药科学,2017,7(15):87-90.
[26]邓国强.通络活血汤治疗糖尿病周围神经病变65例[J].陕西中医,2014,35(8):964-965.
[2]黄少敏,岑忠耿,张伟帅,等.彩色多普勒超声评估透析患者动静脉内瘘血栓及狭窄的临床价值[J].中国超声医学杂志,2016,32(1):31-33.
[3] Bleyer AJ,Scavo VA,Wilson SE,et al. A randomized trial of vonapanitase(PATENCY-1)to promote radiocephalic fistula patency and use for hemodialysis[J]. J Vasc Surg,2019,69(2):507-515.
[4]李春,吕路,重辉,等.血液透析留置针在自体动静脉内瘘中的应用及效果观察[J].护士进修杂志,2018,33(3):254-256.
[5] Bylsma LC,Reichert H,Gage SM,et al. Clinical Outcomes of Arteriovenous Access in Incident Hemodialysis Patients with Medicare Coverage,2012-2014[J]. Am J Nephrol,2019,49(2):156-164.
[6]鄢建军,张仲华,严贺,等.血液透析患者动静脉内瘘栓塞及影响因素研究[J].护理学杂志,2016,31(1):26-28,42.
[7] Kok HK,Maingard J,Asadi H,et al. Percutaneous dialysis arteriovenous fistula banding for flow reduction-a case series[J]. CVIR Endovasc,2018,1(1):27.
[8]侯海晶,王冠苏,蔡佑青,等.中药熏洗联合艾灸治疗对动静脉内瘘早期失功的保护作用[J].安徽中医药大学学报,2017,36(4):56-59.
[9]毛俐婵,王文荣,蒋贤辉,等.中药熏洗联合穴位注射对自体动静脉内瘘成熟影响的临床研究[J].浙江中西医结合杂志,2018,28(5):384-386.
[10]王晓菁,陈海平.慢性肾脏病定义及分期系统修订的进展———2012-KDIGO慢性肾脏病临床管理实践指南解读[J].中华老年多器官疾病杂志,2014,12(5):396-400.
[11] Polimanti AC,de Carvalho Fürst RV,Galego SJ,et al.Influence of intraoperative findings on immediate flow through radial-cephalic arteriovenous wrist fistulas for hemodialysis access[J]. J Vasc Bras,2018,17(3):208-214.
[12]路凌,张兰梅,武军,等.健脾补肾方对脾肾气虚型慢性肾功能衰竭血液透析患者营养状况的影响[J].国际中医中药杂志,2014,36(8):695-698.
[13] Fukasawa M,Isobe M,Nanto S,et al. NF-κB Decoy Oligodeoxynucleotide-Coated Balloon Catheter for Arteriovenous Fistula in Hemodialysis[J]. Kidney Int Rep,2018,4(1):126-138.
[14]陈松,李晓颖,于黔,等.尿毒症血液透析患者动静脉内瘘狭窄超声引导下PTA术后的疗效观察[J].中国超声医学杂志,2018,34(4):342-346.
[15]王建爽,杨文艳,李令娟,等.超声引导尿激酶溶栓治疗维持性血液透析患者动静脉内瘘的临床观察[J].中国医学装备,2016,13(4):78-81.
[16] Saleh MA,El Kilany WM,Keddis VW,et al. Effect of high flow arteriovenous fistula on cardiac function in hemodialysis patients[J]. Egypt Heart J,2018,70(4):337-341.
[17]王立华,姜埃利,魏芳,等.老年动静脉内瘘与长期置管血液透析患者的生存分析[J].中国老年学杂志,2016,36(7):1678-1681.
[18] Cortesi C,Duque JC,Mai S,et al. Assessment of left ventricular mass changes after arteriovenous fistula surgical banding in end-stage renal disease[J]. Saudi J Kidney Dis Transpl,2018,29(6):1280-1289.
[19]陈丽兰,伊娜,李慧枝,等.穴位注射联合中药熏洗治疗糖尿病下肢周围神经病变40例[J].广东医学,2013,34(10):1615-1617.
[20]王宇彤,李莉.益气活血通络法治疗急性心肌梗死介入术后患者43例[J].西部中医药,2017,30(6):68-71.
[21]莫贝霞.中药熏洗联合木瓜酒湿敷对促进动静脉内瘘成熟的应用[J].中国医药科学,2017,7(13):40-43.
[22]廖若夷,张晓,张月娟,等.中药熏洗治疗脑梗死痉挛性瘫痪的效果[J].中国康复理论与实践,2018,24(1):112-115.
[23]张伟,宋世锋,张丕军,等.通络活血方熏洗联合关节松动术治疗骨折后关节僵硬患者的临床疗效及对负面情绪的影响[J].陕西中医,2016,37(4):452-453.
[24]李道睿,王苗苗,于明薇,等.通络活血虫类药对乏氧环境下肺癌血管生成相关细胞因子的影响[J].中国中医药信息杂志,2017,24(9):39-42.
[25]张建英,谭志雄,罗雪琴,等.分析全面护理加红椒通络汤改善血透患者动静脉内瘘功能的临床研究[J].中国医药科学,2017,7(15):87-90.
[26]邓国强.通络活血汤治疗糖尿病周围神经病变65例[J].陕西中医,2014,35(8):964-965.