中药熏蒸配合功能锻炼促进糖尿病肾病患者自体动静脉内瘘成熟的疗效观察

发布时间：2018-04-25 14:08

本文选题：糖尿病肾病 + 自体动静脉内瘘　；参考：《中国中西医结合杂志》2017年06期

【摘要】：目的观察中药熏蒸配合功能锻炼在促进糖尿病肾病患者自体动静脉内瘘成熟方面的作用。方法 52例糖尿病肾病患者均在慢性肾脏病G4~G5期时建立自体动静脉内瘘,手术采用同样的方式,由同一位医生完成。将52例患者随机分成对照组和治疗组,各26例,对照组于术后1周开始功能锻炼;治疗组于术后1周开始中药熏蒸配合功能锻炼。术后2周时,用彩色多普勒测量治疗组单次中药熏蒸治疗前后桡动脉内径、桡动脉血流量、头静脉内径、头静脉血流量;术后4、8、12周用彩色多普勒测量两组患者头静脉内径、头静脉血流量;并随访内瘘使用6个月内并发症(包括:近吻合口狭窄,硬结,血肿,血栓形成)发生率及畅通率。结果与单次中药熏蒸前比较,治疗组单次中药熏蒸后桡动脉、头静脉内径增宽,桡动脉、头静脉血流量增多(P0.01)。与对照组比较,治疗组在术后4、8、12周头静脉血流量增多,头静脉内径增宽,内瘘成熟率增高(P0.05)。与本组术后4周比较,治疗组术后8周头静脉血流量增多,内径逐渐增宽(P0.05)。对照组在4、8、12周头静脉血流量逐渐增多、内径逐渐增宽(P0.05)。与对照组比较,治疗组近吻合口狭窄、硬结、血肿等并发症发生率降低(P0.05);内瘘通畅率虽高,但差异无统计学意义(P0.05)。结论中药熏蒸配合功能锻炼能促进糖尿病患者自体动静脉内瘘发育成熟,减少内瘘使用后的并发症,延长内瘘的使用寿命。
[Abstract]:Objective to observe the effect of Chinese medicine fumigation combined with functional exercise on the maturation of autogenous arteriovenous fistula in patients with diabetic nephropathy. Methods 52 patients with diabetic nephropathy established autogenous arteriovenous fistula in G4~G5 stage of chronic kidney disease. The operation was done in the same way by the same doctor. 52 patients were randomly divided into control group (n = 26) and treatment group (n = 26). At 2 weeks after operation, the diameter of radial artery, radial artery blood flow, cephalic vein and cephalic vein were measured by color Doppler before and after a single Chinese medicine fumigation, and the internal diameter of cephalic vein was measured by color Doppler in both groups at 812 weeks after operation. The incidence of complications (including proximal anastomotic stenosis, sclerotic knot, hematoma, thrombosis) within 6 months after the use of internal fistula was analyzed. Results compared with that before single Chinese medicine fumigation, the radial artery, radial artery and cephalic vein blood flow increased in the treatment group after single Chinese medicine fumigation. Compared with the control group, the blood flow of the cephalic vein increased, the diameter of the cephalic vein widened and the mature rate of the internal fistula increased in the treatment group at 12 weeks after operation (P 0.05). Compared with 4 weeks after operation, the blood flow of cephalic vein increased and the inner diameter gradually widened in the treatment group at 8 weeks after operation. In the control group, the venous blood flow increased and the inner diameter widened gradually at 12 weeks. Compared with the control group, the incidence of complications such as proximal anastomotic stenosis, hard knot and hematoma in the treatment group was lower than that in the control group (P 0.05), while the patency rate of internal fistula was higher, but the difference was not statistically significant (P 0.05). Conclusion Chinese herbal fumigation combined with functional exercise can promote the development and maturity of autogenous arteriovenous fistula in diabetic patients, reduce the complications and prolong the service life of internal fistula.
【作者单位】：衢州市中医医院肾内科;
【基金】：基金项目:钟坚名老中医专家传承工作室(No.GZS2012042)
【分类号】：R587.2;R692.9

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