前列地尔联合罂粟碱对早期自体动静脉内瘘的保护作用探讨

Study on protective effect of alprostadil combined with papaverine in early autologous internal arteriovenous fistula

目的探讨前列地尔联合罂粟碱对早期自体动静脉内瘘(AVF)的保护作用。方法选取2013年7月至2015年12月在该院确诊的终末期肾病需行维持性血液透析患者135例,将其分为A组(50例)和B组(85例)进行比较。两组患者均行桡动脉-头静脉内瘘术(术式为端侧吻合)。A组患者术后给予阿司匹林100 mg口服,每天1次,共7 d;B组患者在术中使用罂粟碱浸润血管表面,同时术后使用前列地尔注射液10μg静脉注射及罂粟碱30 mg肌内注射,每天1次,共7 d。7 d后检测评价两组患者治疗前后血液学指标变化及1个月后AVF成功率。结果 A组中有8例患者术后内瘘丧失功能(失功),出现时间最短1 d,最长18 d,平均(5.8±4.6)d,AVF成功率为84.0%(42/50);B组中有6例患者术后内瘘失功,出现时间最短0.5 d,最长为21 d,平均(9.1±8.3)d,AVF成功率为92.9%(79/85),B组AVF成功率高于A组,差异有统计学意义(P<0.05);A组治疗前后血液学指标检测结果比较,差异均无统计学意义(P>0.05),B组患者治疗后血黏度、红细胞聚集数、D-D、Fib检测结果与治疗前和A组比较,差异均有统计学意义(P<0.05)。结论前列地尔联合罂粟碱治疗可以预防早期动静脉内瘘术后血管痉挛及血栓形成,提高AVF成功率。

Objective To study the protective effect of alprostadil and papaverine on early autologous internal arteriove-nous fistula（AVF）. Methods A total of 135 patients with end-stage renal disease needing maintenance hemodialysis in our hos-pital from July 2013 to December 2015 were selected and divided into the group A（50 cases） and B（85 cases）. The two groups were performed the radial artery-head venous internal fistula（end-to-side anastomosis operative mode）.The group A was postoper-atively given oral aspirin 100 mg,once daily for 7 d;the group B intraoperatively used papaverine for infiltrating the vessel sur-face,meanwhile alprostadil injection 10μg was postoperatively given by intravenous injection and papaverine 30 mg by intramus-cular injection,once daily for 7 d. The changes of blood indicators after 7 d were detected and evaluated before and after treat-ment,the AVF success rate after 1 month was evaluated. Results In the group A,8 cases AVF lost the postoperative function, the shortest occurrence time was 1d and longest occurrence time was 18 d,averaged（5.8±4.6）d,the AVF success rate was 84.0%（42/50）;in the group B,6 cases of AVF lost postoperative function,the shortest occurrence time was 0.5 d and longest occurrence time was 21 d,averaged（9.1±8.3）d,the AVF success rate was 92.9%（79/85）,the AVF success rate in the group B was higher than that in the group A with statistical difference（P〈0.05）,the detection results of hematological indexes in the group A had no statistically significant differences between before and after treatment（P〉0.05）. The detection results of blood viscosity,RBC aggre-gation number,D-D and Fib in the group B had statistically significant differences compared with the group A （P〈0.05））. Conclu-sion Alprostadil combined with papaverine can prevent the vasospasm and thrombosis after early internal AVF operation and in-creases the AVF success rate.