前列地尔干乳剂对糖尿病肾病动静脉内瘘血管流量的影响

Application of Alprostadil Dry Emulsion in Diabetic Nephropathic Arteriovenous Fistulation

【目的】探讨注射用前列地尔干乳剂对糖尿病肾病造瘘血管血流量的影响。【方法】选择本院收治的糖尿病肾病终末期肾衰行血液透析的患者46例，随机分为A组和B组，均行桡动脉-头静脉端端吻合术。A组患者术后予常规换药处理；B组术后给予注射用前列地尔干乳剂10μg静脉注射，共10d。采用彩色血管多普勒超声每隔3d检查两组患者吻合口血流量，观察比较其变化。【结果】①治疗10d后彩色多普勒超声检查A组血流量为31957mL／min；B组血流量为42572mL／min，B组内瘘血流量血明显高于A组，且两组相比较差异有显著性（P〈0．05）。②A组有12例术后出现内瘘处血流减弱，血管震颤减弱、血管杂音降低，发生率为52．17％（12／23），经保守治疗同时加强前臂功能锻炼1周后好转；B组有2例术后d3出现血管震颤及血管杂音减弱，发生率为8．69％（2／23），明显低于A组，且两组相比较差异有显著性（P〈0．05）。2例患者加强功能锻炼2d后好转；有1例术后次日出现术肢肿胀，瞩其抬高患肢，1周后肿胀逐渐消失。两组均未发现切口感染及术区渗漏液体情况。【结论】注射用前列地尔干乳剂有预防糖尿病肾病动静脉内瘘术后狭窄或闭塞，增加血流量、提高手术成功率的作用。

[Objective] To explore the application of alprostadil dry emulsion in patients with diabetic nephro- pathic arteriovenous fistulation. [Methods] A total of 46 diabetics with chronic renal failure were divided into groups A and B. Both groups underwent radial artery-cephalic vein standard fistulation. Group A received conventional treatment after operation while group B group had an intravenous injection of alprostadil 10μg for 10 days. And the anastomotic flow was observed once by color vascular Doppler ultrasound every 4 days. [Results] Color Doppler uhrasonography revealed that blood flow in fistula was 319 57 ml/min in group A versus 425 72 ml/min in group B after 10-day treatment. Blood flow increased compared to those before treatment with statistical significance （ P〈0.05）. And 12 patients in group A showed that vascular tremor in fistula weakened in the first day after operation and vascular murmur decreased. Recovery occurred within 1 week through strengthening hand function training. Among 3 patients with fistula occlusion, 2 patients in group B showed that vascular tremor in fistula weakened and vascular murmur decreased in the third day after operation. Recovery occurred within 2 days after strengthening function training. One case in group B suffered limb swollen in the day after operation. And it resolved automatically within 1 week. There were no wound infection and bleeding in both groups. [Conclusion] Alprostadil dry emulsion may prevent stenosis or occlusion, increase blood flow and improve the success rate of surgery after arteriovenous fistulation.