赵化南辨证用药热敷促进自体动静脉内瘘成熟的临床研究

发布时间：2018-02-11 02:41

本文关键词： 赵化南辨证用药中药热敷慢性肾衰竭血液透析动静脉内瘘发育成熟多普勒彩超血流量　出处：《南京中医药大学》2016年博士论文　论文类型：学位论文

【摘要】：目的：观察全国名老中医赵化南辨证用药热敷对血液透析患者动静脉内瘘成熟的临床疗效,并初探中药热敷促进动静脉内瘘成熟、改善动静脉内瘘血流量的可能机理。方法：采用前瞻性队列研究方法,病例选择为连云港市中医院肾病科拟行动静脉内瘘手术的血液透析患者60例,随机分为观察组30例及对照组30例。所有患者均选用腕关节远侧端桡动脉与头静脉行自体动静脉内瘘成形术,吻合方式采用端-侧吻合方式。对照组在拟行动静脉内瘘手术前五天开始用热毛巾热敷,术后第2天开始予喜疗妥涂擦内瘘处；观察组在拟行动静脉内瘘手术前五天采用赵化南益气活血通络方热敷,术后第2天开始采用清热解毒活血通络中药局部热敷。每次30分钟,每天两次,疗程均为2周。密切监测内瘘血管情况,及时更换敷料,术后注意监测血压、术肢防压。观察指标为：①手术后1个月内动静脉内瘘通畅情况；②内瘘初次使用时间。③术后1月多谱勒超声测定内瘘血液量。并记录治疗过程中产生的不良反应。应用SPSSl6.0统计软件进行数据分析,计量资料数据以均数±标准差(x±s)表示,2组比较采用t检验,计数资料比较采用X2检验,P0.05为有显著性差异。结果：1.两组内瘘通畅情况：观察组1月内内瘘通畅29例,1例出现栓塞；对照组6例出现栓塞。观察组内瘘通畅情况优于对照组,差异有统计学意义(P0.05)。2.内瘘初次使用时间：初次使用内瘘时间观察组为30±6天,对照组为35±5天,差异有统计学意义(P0.01)；提示中药局部热敷对促进内瘘发育成熟有较好的作用。3.术后1月多谱勒彩超测定：观察组内瘘血流量(280±54)ml/min,对照组(240± 62)ml/min,差异有统计学意义(P0.01)；提示中药局部热敷对改善内瘘血流量有较好作用。结论：1.赵化南名老中医采用辨证用药局部热敷促进内瘘成熟的临床疗效确切,可以提高血液透析患者动静脉内瘘吻合术的成功率。并具有良好的安全性。2.术前局部辨证多为气虚血瘀证,采用中药益气活血通络方局部热敷,软化、扩张静脉血管,增加血流量,改善术前血管条件,可以提高手术成功率；3.术后局部辨证多为瘀热阻络证,采用中药清热解毒活血通络方局部热敷,减轻术后血管炎症渗出、肿胀,减少组织出血、疼痛等并发症,并减轻血管内膜增生,可以促进动静脉内瘘术后发育成熟。4.手术前、后采用中药方局部热敷均有活血化瘀方药,可能是通过改善血流变和血流动力学作用而改善手术血管条件,提高动静脉内瘘手术成功率；其抗血栓抗炎作用可预防动静脉内瘘初期瘘管血栓形成,抑制血管内膜炎症。其具体作用机制有待于进一步实验研究证实。
[Abstract]:Objective: To observe the old Chinese national Zhao Huanan on clinical curative effect of TCM drugs to compress venous fistula maturation of hemodialysis patients, and of the traditional Chinese medicine hot compress promoting arteriovenous fistula maturation, improve the dynamic mechanism of blood flow within the venous fistula. Methods: a prospective cohort study method, 60 cases of hemodialysis patients with intravenous action the fistula surgery department of nephropathy of Lianyungang Hospital of Traditional Chinese Medicine were randomly divided into observation group of 30 cases and 30 cases in the control group. All patients with wrist distal radial artery and cephalic vein arteriovenous fistula plasty anastomosis by end to side anastomosis. In the control group to five days of intravenous action fistula before the operation began with a hot towel, second days after the operation began to Hirudoid fistula inunction; observation group in five days to action of internal arteriovenous fistula surgery using Zhao Huanan Yiqi Huoxue Tongluo Decoction compress, surgery Second days after the detoxification Huoxue Tongluo Decoction of local hot compress. Every 30 minutes, two times a day for 2 weeks. Close monitoring of arterial venous fistula, postoperative change of dressing, pay attention to monitoring blood pressure, limb pressure proof. Observation index: fistula patency within 1 months in the movement the first time after surgery; fistula using in January. Postoperative Doppler ultrasound determination of internal fistula blood volume. And record the adverse reaction during the treatment. The application of SPSSl6.0 statistical software for data analysis, measurement data to mean + standard deviation (x + s) said that the 2 groups were compared with t test, counting data were compared with X2 test, P0.05 was the significant difference. Results: the fistula patency 1. in two groups: the observation group in January within fistula patency in 29 cases, 1 cases of embolization; 6 cases in the control group. The observation group embolization of fistula patency than the control group, with statistical difference Learn the meaning of (P0.05).2. in the first time use fistula fistula: the first time in the observation group was 30 + 6 days, the control group was 35 + 5 days, the difference was statistically significant (P0.01); the traditional Chinese medicine hot compress maturity determination of January Doppler ultrasonography good effect after.3. to promote the development of internal fistula: observation group of fistula blood flow (280 + 54) ml/min, the control group (240 + 62) ml/min, the difference was statistically significant (P0.01); the traditional Chinese medicine has a good effect on the improvement of local hot compress fistula blood flow. Conclusion: 1. Zhao Huanan old Chinese medicine with TCM drugs to promote the clinical curative effect of local hot compress into the fistula mature exactly, can improve the arteriovenous fistula in hemodialysis patients. The success rate of anastomosis and has good safety.2. preoperative local differentiation of qi deficiency and blood stasis, the use of Chinese medicine Yiqi Huoxue Tongluo Decoction local hot compress, softening, dilated veins, increase blood flow, improve Preoperative vascular conditions, can improve the success rate of surgery; 3. postoperative local syndrome differentiation is blood stasis resistance collaterals, with Qingre Jiedu Huoxue Tongluo prescription local hot compress, reduce vascular inflammatory exudation, postoperative swelling, reduce bleeding, pain and other complications, and reduce neointimal hyperplasia, can promote the development of mature.4. arteriovenous surgery fistula before, after using the prescription of local hot compress has promoting blood circulation to remove blood stasis, may be improved by improving the operation conditions of vascular blood flow and hemodynamic effects, improve the success rate of surgery of internal arteriovenous fistula; its antithrombotic and anti-inflammatory effects can prevent artery fistula fistula thrombus formed in the early stage of intravenous, inhibition of intimal inflammation. The specific mechanism needs further experimental studies.

【学位授予单位】：南京中医药大学
【学位级别】：博士
【学位授予年份】：2016
【分类号】：R249;R259

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