肾病维持性血透患者自体动静脉内瘘早期栓塞的预防处理研究

Prevention early embolization of maintenance hemodialysis autogenousarteriovenous fistula in nephrotic patients

目的 探讨阿司匹林对肾病维持性透析患者自体动静脉内瘘（autogenousarteriovenousfistula,AVF）早期栓塞的预防作用及安全性.方法 46例拟行维持性血液透析患者随机分为观察组23例和对照组23例,两组患者均选择自体AVF;观察组口服阿司匹林预防血栓;对照组给予华法林;比较两组患者内瘘通畅率、内瘘血流量和透析前后凝血指标变化情况,并记录两组患者不良反应发生情况.结果 两组患者透析6个月后内瘘通畅率相比差异无统计学意义（P＞0.05）,透析12个月后观察组内瘘通畅率显著高于对照组（P＜0.05）.超声多普勒内瘘血流量检查发现,透析前、透析3个月后、6个月后两组患者内瘘血流量相比差异无统计学意义（P＞0.05）,透析9个月后、12个月后观察组内瘘血流量显著高于对照组（P＜0.05）.透析12个月后,观察组PT、APTT显著高于对照组,FIB显著低于对照组,两组间比较差异具有统计学意义（P＜0.05）.结论 阿司匹林能够有效预防肾病维持性透析患者AVF早期栓塞,对提高内瘘通畅率和血流量具有明显效果,且安全性较高,值得临床应用。

Objectives To explore the clinical efficacy and safety of Aspirin in prevention early embolization of nephropathy maintenance hemodialysis patients with autologous arteriovenousfistula.Methods Total of 46 cases of maintenance hemodialysis patients were divided into the observation group（23 cases）and control group（23 cases）,two groups were selected for autologous AVF;the observation group oral aspirin for the prevention of thrombosis;the control group received Warfarin.Compared of two groups of patients with fistula patency rate,fistula blood flow and blood coagulation indexes,and recorded the occurrence of adverse reactions of two groups.Results After 6 months of dialysis,two groups dialysis fistula patency rate with no significant difference （P 〉 0.05）,dialysis 12 months later observation group fistula patency rate was significantly higher than the control group（P 〈0.05）.Ultrasonic Doppler blood flow of internal fistula examination found that pre dialysis,dialysis after 3 months and 6 months after the two groups of patients with fistula blood flow with no significant difference （P 〉 0.05）,dialysis after 9 months and 12 months observation group fistula blood flow was significantly higher than that in control group（P 〈0.05）.Dialysis 12 months later,the observation group PT,APTT were significantly higher than that of the control group,FIB was significantly lower than that of the control group（P 〈 0.05）.Conclusions Aspirin can effectively prevent nephropathy in patients with maintenance hemodialysis in AVF,has obvious effect on improving the fistula patency rate and blood flow,with high safety,and worthy of clinical application.