中药熏蒸配合功能锻炼促进糖尿病肾病患者自体动静脉内瘘成熟的疗效观察

Effect of Traditional Chinese Medicine Fumigation Combined with Functional Exercise on Native Arteriovenous Fistula Maturation in Patients with Diabetic Nephropathy

目的观察中药熏蒸配合功能锻炼在促进糖尿病肾病患者自体动静脉内瘘成熟方面的作用。方法 52例糖尿病肾病患者均在慢性肾脏病G4~G5期时建立自体动静脉内瘘,手术采用同样的方式,由同一位医生完成。将52例患者随机分成对照组和治疗组,各26例,对照组于术后1周开始功能锻炼;治疗组于术后1周开始中药熏蒸配合功能锻炼。术后2周时,用彩色多普勒测量治疗组单次中药熏蒸治疗前后桡动脉内径、桡动脉血流量、头静脉内径、头静脉血流量;术后4、8、12周用彩色多普勒测量两组患者头静脉内径、头静脉血流量;并随访内瘘使用6个月内并发症(包括:近吻合口狭窄,硬结,血肿,血栓形成)发生率及畅通率。结果与单次中药熏蒸前比较,治疗组单次中药熏蒸后桡动脉、头静脉内径增宽,桡动脉、头静脉血流量增多(P<0.01)。与对照组比较,治疗组在术后4、8、12周头静脉血流量增多,头静脉内径增宽,内瘘成熟率增高(P<0.05)。与本组术后4周比较,治疗组术后8周头静脉血流量增多,内径逐渐增宽(P<0.05)。对照组在4、8、12周头静脉血流量逐渐增多、内径逐渐增宽(P<0.05)。与对照组比较,治疗组近吻合口狭窄、硬结、血肿等并发症发生率降低(P<0.05);内瘘通畅率虽高,但差异无统计学意义(P>0.05)。结论中药熏蒸配合功能锻炼能促进糖尿病患者自体动静脉内瘘发育成熟,减少内瘘使用后的并发症,延长内瘘的使用寿命。

Objective To observe the effect of traditional Chinese medicine fumigation combined with functional exercise on native arteriovenous fistula maturation in patients with diabetic nephropathy. Methods Totally 52 cases of patients with diabetic nephropathy established native artenovenous fistula on the wrist on CKD 4 -5. The operations of arterio-venous fistula formation were done by one surgeon. 52 patients were randomly assigned to the treatment group （26 cases） and control group （26 cases ）. 1 weeks after operation,The control group began functional exercise, and the treatment group began functional exercise with treatment of traditional Chinese medicine fumigation. 2 weeks after the operation, blood flow and the diameter of radial artery and cephalic vein were measured by Doppler ultrasonography before and after single Chinese medicine fumigation in treatment group. Blood flow and the diameter of cephalic vein were measured by Doppler ultrasonography after the surgery for week 4, 8 and 12 in two groups. The complication rate（including： anastomotic stenosis, induration, hematoma and thrombosis） and patency rate of the fistula were observed within 6 months. Results In the treatment group, after single treatment of traditional Chinese medicine fumigation ,blood flow in radial artery and cephalic vein were increased, the diameter of radial artery and cephalic vein were widened （P 〈0.01 ）. Compared with control group,blood flow and diameter of cephalic vein, and fistula maturation rate in the treatment group were higher at week 4,8 and 12（P 〈0.05）. And at week 8, blood flow and diameter of cephalic vein were higher than those at week 4 in the treatment group （P 〈0.05）. In the control group, blood flow and diameter of cephalic vein were increased gradually at week 4,8 and 12 （P 〈0. 05）. The incidence of complications （including： anastomotic stenosis, induration and hematoma ） in the treatment group was Iower（P 〈0.05）, and the fistula patency rate was higher,but there was no significant difference between the 2 groups （P 〉0.05）. Conclusion Traditional Chinese medicine fumigation combined with functional exercise can promote the the fistula maturation rate and reduce complications, and prolong the service life of the fistula.