微针阵列给药技术对动静脉内瘘血管保护作用的研究

Protective effect of micro needle array drug delivery technology on the blood vessel of arteriovenous fistula

目的 探讨多磺酸粘多糖乳膏加微针阵列给药技术对动静脉内瘘血管的保护作用.方法 选择应用自体动静脉内瘘行维持性血液透析、病情稳定的尿毒症患者80例,随机分为对照组和研究组.对照组局部应用多磺酸粘多糖乳膏治疗,研究组在对照组的基础上加用无痛微针阵列技术,分别观察两组患者12个月内穿刺疼痛感、穿刺失败次数、静脉炎、血管硬化、内瘘狭窄、栓塞、假性动脉瘤、肿胀手综合征等血管并发症,多普勒超声技术测量两组患者动静脉内瘘的血流量、血管内径等的变化.结果 （1）与对照组比较,治疗组研究结束时穿刺疼痛感（2.71±0.11 与2.76±0.14,t=2.21,P〈0.05）、穿刺失败次数（38 次与73次,χ^2=11.425,P〈0.05）、静脉炎（2例与8例,χ^2=4.341,P〈0.05）、血管硬化（2例 与 9例,χ^2=5.446,P〈0.05）等并发症的发生率明显减少.（2）血管内瘘血流量对照组治疗前后分别为（859.7±148.3） ml/min 与（946.5±169.2） ml/min,差异有统计学意义（t=2.356,P〈0.05）,而治疗组治疗前后血管内瘘血流量、[（824.6±171.5） ml/min 与（1218.1±241.9） ml/min]、头静脉内径[（5.59±0.74） mm与（6.02±0.57） mm]、头静脉流速[（94.23±27.35） cm/s与（115.85±36.63） cm/s]比较差异均有统计学意义（t值分别为 8.212、2.382、2.877,P均〈0.05）,且两组治疗后血管内瘘血流量、头静脉内径、头静脉流速比较差异均有统计学意义（t值分别为5.3612、2.152、2.281,P均〈0.05）.结论 多磺酸粘多糖乳膏加微针阵列给药技术能减少动静脉内瘘血管通路的并发症,改善血管的内径,增加血流量.

Objective To investigate the protective effect of mucopolysaccharide polysulfate cream（MPC） and micro needle array drug delivery technologarray（MNADDT） on the blood vessel of arteriovenous fistula.Methods Eighty cases maintenance hemodialysis patients with autogenous arteriovenous fistula were randomly divided into control group（with the treatment of MPC） and study group（with the treatment of MPC plus MNADDT）,40 patients in each group.Both groups were studied for the duration of 12 months.The vascular complications of puncture pain sense,puncture failure times,phlebitis,hardening of the arteries,internal fistula stenosis or embolism,pseudoaneurysm,swollen hands comprehensive syndrome of two groups were observed,and the changes of arteriovenous fistula blood flow,blood vessel diameter by Doppler ultrasound were observed in the two groups for 12 months.Results （1）The incidence of puncture pain（2.71±0.11 vs.2.76±0.14,t=2.21,P〈0.05）,puncture failure times（38 times vs.73 times,χ^2=11.425,P〈0.05）,phlebitis（2 cases vs.8 cases,χ^2=4.341,P〈0.05） and blood vessel sclerosis（2 cases vs.9 cases,χ^2=5.446,P〈0.05） of the treatment group were significantly lower than that of the control group during the study（P〈0.05）.（2）Blood flow of arteriovenous fistulain of control group before and after treatment were （859.7±148.3） ml/min and （946.5±169.2） ml/min respectively,and the difference was significant（t=2.356,P〈0.05）.While blood flow of arteriovenous fistulain,cephalic vein diameter,head of venous flow velocity of study group before and after treatment were （824.6±171.5） ml/min and （1 218.1±241.9） ml/min,（5.59±0.74） mm and （6.02±0.57） mm,（94.23±27.35） cm/s and （115.85±36.63） cm/s,respectively,and the differences were significant（t=8.212,2.382,2.877,P〈0.05）,there were no significantly changes in the above indexes in the study group after treatment（t=5.3612,2.152,2.281,P〈0.05）.Conclusion MPC plus MNADDT can reduce the vascular complications of arteriovenous fistula,improve blood vessel diameter and increase blood flow.