远红外线照射对维持性血液透析患者自体内瘘的疗效观察

Clinical observation of far infrared radiation on autogenous arteriovenous fistula in maintenance hemodialysis patients

目的探讨远红外线照射的物理疗法对维持性血液透析患者自体内瘘的临床疗效。方法选取贵州省人民医院血液透析中心使用自体内瘘的维持性血液透析1年以上的患者80例,将其随机分为20 min组、40 min组、60 min组和对照组各20例,3个治疗组每次透析时分别予以远红外线照射20、40和60 min,每周3次,治疗6个月。比较4组的血流量变化及内瘘功能障碍发生率,并检测单次透析前后4组血高敏C反应蛋白(hs CRP)和白介素-8(IL-8)浓度。结果半年后治疗组单次透析中血流量增值均明显高于对照组(P<0.05)。半年后治疗前血流量增加值及治疗后增加值也明显高于对照组(P均<0.05),且经过半年远红外线照射,治疗后血流量增加值与治疗前血流量增加值的差值治疗组仍然明显高于对照组(P<0.05)。40 min及60 min治疗组血流量增值与20 min治疗组相比明显增加(P<0.05);40 min组与60 min组间血流量增值差异无统计学意义。应用远红外线照射治疗半年后,各治疗组维持性血液透析患者体内血hs CRP及IL-8差值与对照组相比有下降趋势,差异无统计学意义(P>0.05),但40 min及60 min治疗组患者的炎症因子较20 min治疗组有下降趋势。结论选择每周3次,每次40 min的远红外照射的治疗方式可以达到最佳效果,值得临床推广使用。

Objective To investigate the clinical efficacy of combined physical therapy, far infrared radiation on autogenous arteriovenous fistula in patients with chronic kidney disease undergoing maintenance hemodialysis. Methods Patients used autogenous arteriovenous fistula more than 1 year in the hemodialysis center of Guizhou Provincial People＇s Hospital were randomly divided into 20-min group, 40-min group, 60-min group and the control group. Patients in the 20-min group, 40-min group and 60-min group were treated with far-infrared radiation for 20, 40 and 60 min, respectively, 3 times a week, for 6 months. Blood flow changes and the incidence of fistula dysfunction were recorded. The levels of high-sensitivity C-reactive protein（hs CRP） and interleukin-8（IL-8） were detected by enzyme-linked immunosorbent assay（ELISA）. Results As compared with that in the control group after far-infrared radiation therapy for 6 months, the blood flow value in each treatment group was significantly higher（P〈0.05）; the blood flow values in 40-min and 60-in group were higher than those in 20 min group（P〈0.05）; there was no significant difference between the 60-min and 40-min group. After 6 months of treatment with far-infrared radiation, the serum levels of hs CRP and IL-8 were decreased as compared with those in the control group, but the difference was not statistically significant（P〉0.05）; however, the inflammation factors both in the 40-min group and 60-min group had a downward tendency as compared with those in the 20-min group. Conclusion Far-infrared radiation treatment for 40 min once and 3 times a week can achieve the best efficacy, which is worthy of being used clinically.