活血化瘀药对尿毒症患者动静脉内瘘成熟影响的Meta分析

发布时间：2018-06-11 12:02

本文选题：中药 + 活血化瘀　；参考：《湖北中医药大学》2017年硕士论文

【摘要】：目的维持性血液透析(maintenance hemodialysis,MHD)是终末期肾脏病(end-stage renal disease,ESRD)患者最主要的治疗方法之一。因此,在血液透析的整个过程中,建立血液透析所需要的长期血管通路就显得非常重要,血管通路被认为是维持性血液透析患者的“生命线”。目前在国内以及国际上,自体动静脉内瘘(autogenous arteriovenous fistula,AVF)都是公认的首选的长期血管通路,但其成熟率偏低成为困扰临床医生的难题。目前,临床上还没有真正行之有效地促进AVF成熟的方法。西医多采用阿司匹林、双嘧达莫等抗血小板药或抗凝血药等治疗措施,但有限的随机临床研究并未发现这些药物能有效地提高AVF成熟。中医药治疗在这方面有自己的特色和优势。活血化瘀药被认为能够使血管扩张,改善微循环,抑制血小板的黏附、聚集和释放,抑制血栓素合成酶的活性,具有抗血栓形成和溶血栓的作用,另外,还能清除氧自由基,减轻血管内皮损伤。在此背景下,我们探讨活血化瘀药是否真正有助于缩短内瘘成熟时间,提高内瘘成熟率,改善内瘘血流量,减少术后并发症发生率等,以便为临床实际提供一条新的思路。方法通过计算机,全面系统地检索知网、万方、维普等相关数据库,搜集国内2006年1月1日至2016年12月31日公开发表的关于活血化瘀药促进动静脉内瘘成熟的文献。我们选取的关键词为“中药”或“活血化瘀药”、“动静脉内瘘”或“血管通路”,选择随机对照试验,然后对文献进行归纳、整理,提取有关数据,并采用Cochrane网提供的Review Manager(Rev Man)version 5.2软件对提取的数据进行Meta分析及系统评价。结果最终共纳入15篇符合要求的文献,把15篇文献研究列为15个研究项目,共包含临床随机对照试验合计1050例,包含实验组524例观察对象,对照组526例。Meta分析结果:1.关于内瘘成熟时间的比较:各研究合并效应量MD=-10.31,95%CI[-13.34,-7.28]。各研究合并后,实验组和对照组相比,差异具有统计学意义(Z=6.67,P0.00001),表明实验组在缩短内瘘成熟时间方面优于对照组;2.关于内瘘血流量的比较:各研究合并效应量MD=57.69,95%CI[36.28,79.10]。各研究合并后,实验组和对照组相比,差异具有统计学意义(Z=5.28,P0.00001),表明实验组在增加内瘘血流量方面强于对照组;3.关于术后并发症发生率的比较:各研究合并效应量OR=0.19,95%CI[0.08,0.42]。各研究合并后,实验组和对照组相比,差异具有统计学意义(Z=4.10,P0.0001),表明在降低术后并发症发生率方面,实验组优于对照组;4.关于内瘘成熟情况的比较:实验组在术后4周、6周、8周及12周内瘘成熟情况均好于对照组,差异具有统计学意义(P值分别为0.0006,0.04,0.007,0.0008);5.两组患者在首次穿刺成功率方面的比较:各研究合并效应量OR=5.64,95%CI[1.92,16.55]。各研究合并后,实验组和对照组相比,差异具有统计学意义(Z=3.15,P0.002),表明实验组在首次穿刺成功率方面更高。结论与西医相比,活血化瘀药在促进动静脉内瘘成熟方面有自己的特色和优势。在终末期肾脏病患者拟行动静脉内瘘手术术前、术后使用活血化瘀类中药,可大大减少动静脉内瘘成熟时间,增加动静脉内瘘成熟率,增加血液透析时内瘘血流量,减少术后并发症发生率,提升首次穿刺成功率,值得深入研究及临床推广。
[Abstract]:Objective maintenance hemodialysis (maintenance hemodialysis, MHD) is one of the most important treatments for patients with end-stage renal disease (ESRD). Therefore, in the whole process of hemodialysis, the establishment of long-term vascular access needed for hemodialysis is very important. Vascular access is considered to be a maintenance hemodialysis. Analysis of the "lifeline" of patients. At present, autogenous arteriovenous fistula (AVF) is generally accepted as the preferred long-term vascular access at home and abroad, but its low maturity has become a difficult problem for the clinicians. At present, there is no real effective method to promote the maturation of AVF. Use of aspirin, dipyridamole and other antiplatelet drugs or anticoagulants, but limited randomized clinical studies have not found that these drugs can effectively improve AVF maturation. Traditional Chinese medicine has its own characteristics and advantages in this regard. Blood activating and stasis removing drugs are considered to be able to make blood Guan Kuozhang, improve microcirculation and inhibit platelet adhesion. Attach, gather and release, inhibit the activity of thromboxane synthase, have antithrombotic formation and thrombolytic effect. In addition, it can also remove oxygen free radicals and reduce vascular endothelial damage. In this context, we explore whether the blood circulation removing drugs really help to shorten the maturity of internal fistula, improve the maturity of internal fistula, improve the blood flow of internal fistula, and reduce the postoperative blood flow. The incidence of complications and so on, in order to provide a new idea for clinical practice. Methods through the computer, a comprehensive and systematic retrieval of the network, Wanfang, VP and other related databases, collected from January 1, 2006 to December 31, 2016 published in China on promoting blood circulation and stasis drugs to promote the maturation of internal arteriovenous fistula. "Traditional Chinese medicine" or "blood circulation and stasis removing drugs", "arteriovenous fistula" or "vascular access", selected randomized controlled trials, and then summarized the literature, collate and extract the relevant data, and used the Review Manager (Rev Man) version 5.2 software provided by Cochrane net to carry out Meta analysis and systematic evaluation of the extracted data. The results were finally included. 15 articles in accordance with the requirements, 15 literature studies were listed as 15 research projects, including 1050 cases of clinical randomized controlled trials, including 524 cases in the experimental group and 526 cases in the control group with.Meta analysis: 1. the comparison of the maturity of internal fistula: the combined effect of MD=-10.31,95%CI[-13.34, and the combination of -7.28]. studies Compared with the control group, the difference was statistically significant (Z=6.67, P0.00001), indicating that the experimental group was better than the control group in shortening the maturity of internal fistula; 2. the comparison of the blood flow of internal fistula: after the study of the combined effect of MD=57.69,95%CI[36.28,79.10]., the difference was statistically significant compared with the control group (Z=5.2 8, P0.00001), indicating that the experimental group was stronger than the control group in increasing the flow of internal fistula; 3. the comparison of the incidence of postoperative complications: after the study of the combination effect of each study, the difference was statistically significant (Z=4.10, P0.0001) compared with the control group (Z=4.10, P0.0001), indicating that the incidence of postoperative complications was reduced. The experimental group was superior to the control group; 4. the comparison of the maturity of internal fistula: the maturation of the fistula in the experimental group was better than the control group at 4 weeks, 6 weeks, 8 weeks and 12 weeks after the operation. The difference was statistically significant (P value was 0.0006,0.04,0.007,0.0008), and the comparison of the rate of first puncture success in the 5. two groups: the combined effect of OR=5.64,95%C After the I[1.92,16.55]. study, the experimental group and the control group were statistically significant (Z=3.15, P0.002), indicating that the experimental group was more successful in the first puncture success rate. Conclusion compared with western medicine, it has its own characteristics and advantages in promoting the maturation of arteriovenous fistula. Before operation of internal fistula operation, the use of traditional Chinese medicine for activating blood and removing stasis after operation can greatly reduce the maturity of arteriovenous fistula, increase the maturity of arteriovenous fistula, increase the blood flow of internal fistula, reduce the incidence of postoperative complications, and improve the success rate of the first puncture, which is worthy of further study and clinical popularization.
【学位授予单位】：湖北中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R692.5

【参考文献】