尿毒症血液透析患者首次内瘘术后应用罂粟碱联合前列地尔的临床观察

Clinical Observation of the Application of Alprostadil Combined with Papaverine in Uremic Hemodialysis Patients after Initial Arteriovenous Fistula

目的:观察罂粟碱联合前列地尔对尿毒症血液透析患者首次内瘘术后凝血指标及并发症的影响。方法:将2015年2-6月我院118例拟行首次内瘘术的尿毒症血液透析患者按随机数字表法分为对照组和观察组,各59例。两组患者术前3 d至术后10 d给予血透内瘘修护仪局部照射30 min,tid。对照组患者术后即刻给予前列地尔注射液10μg,iv,qd;观察组患者在对照组基础上加用注射用盐酸罂粟碱30 mg,iv,qd。两组患者均治疗10 d。比较两组患者瘘口血流量、透析血流量及首次透析时间,并观察两组患者治疗前后血浆凝血酶原时间(PT)、凝血活酶时间(APTT)、纤维蛋白原(Fib)、血小板计数(PLT)及C反应蛋白(CRP)水平,观察两组患者术后并发症发生情况。结果:观察组患者瘘口血流量、透析血流量显著高于对照组,首次透析时间显著短于对照组,差异均有统计学意义(P<0.05)。治疗前,两组患者PT、APTT、Fib、PLT、CRP水平比较,差异无统计学意义(P>005)。治疗后,两组患者APTT、CRP水平显著升高,Fib显著降低,且观察组患者上述指标变化显著优于对照组,差异均有统计学意义(P<0.05);两组患者PT、PLT水平组间比较,差异无统计学意义(P>0.05)。两组患者治疗后内瘘感染、伤口出血量>10 m L发生率比较,差异均无统计学意义(P>0.05);观察组患者内瘘闭塞、瘘口血栓发生率显著低于对照组,差异均有统计学意义(P<0.05)。结论:尿毒症血液透析内瘘术后应用罂粟碱联合前列地尔,能有效预防内瘘术后炎症反应,防止内瘘血栓形成及内瘘闭塞,促进内瘘成熟。

OBJECTIVE： To observe the effects of alprostadil combined with papaverine on blood coagulation indexes and complications in uremic hemodialysis patients after initial arteriovenous fistula. METHODS：One hundred and eighteen uremic hemodialysis patients undergoing initial arteriovenous fistula in our hospital during Feb.-Jun. 2015 were divided into control group and observation group according to random number table, with 59 cases in each group. Both groups received local irradiation with hemodialysis internal fistula repair instrument 30 min, tid, from 3 days before surgery to 10 days after surgery. Control group was treated with Alprostadil injection 10 μg, iv, qd, immediately after surgery. Observation group was additionally treated with Papaverine injection 30 rag, iv, qd, on the basis of control group. Both groups received treatment for 10 d. The orificium fistulae blood flow, hemodialysis blood flow and the time of initial hemodialysis were compared between 2 group. The plasma prothrombin time （PT）, activated partial thromboplastin time （APTT）, fibrinogen （Fib）, platelet count （PLT） and C-reactive protein （CRP） levels were observed in 2 groups before and after surgery. The occarrence of postoperative complications was observed. RESULTS： The orificium fistulae blood flow and hernodialysis blood flow of observation group were significantly higher than those of control group, and initial hemodialysis time was significantly shorter than control group, with statistical significance （P〈0.05）. Before surgery, there was no statistical significance in PT, APTT, Fib, PLT and CRP between 2 groups （P〉0.05）. After surgery, APTT and CRP of 2 groups were increased significantly, Fib was decreased significantly; the above indexes of observation group was significantly better than that of control group, with statistical significance （P〈0.05）. There was no statistical significance in PT, PLT between 2 groups （P〉0.05）. There was no statistical significance in the incidence of internal fistula infection and postoperative wound bleeding volume〉 10 mL between 2 groups （P〉0.05）. The incidence of internal fistula occlusion and orificium fistulae thrombus in observation group were significantly lower than control group, with statistical significance （P〈0.05）. CONCLUSIONS： The applica-tion of alprostadil combined papaverine on uremic hemodialysis patients after initial arteriovenous fistula can effectively prevent inflammation reaction, fistula thrombus formation and fistula occlusion, and improve the maturation of fistula.