壳聚糖和远红外线联合治疗在改善自体动静脉瘘的血管通路流量中的作用

Effect of combined treatment of chitosan and far-infrared ray in improving the blood flow of arteriovenous fistula

目的探讨壳聚糖联合远红外线治疗在改善自体动静脉瘘血管流量中的效果。方法选取我院血液透析室在2015年1月~2016年2月收治的采用自体动静脉瘘维持血液透析的尿毒症患者66例,按照随机数字表法分为远红外线组、壳聚糖与远红外线联合治疗组、对照组,各22例;远红外线组在透析开始后对动静脉瘘处进行照射,每次40min;联合治疗组远红外线照射前在动静脉瘘处给予壳聚糖喷雾剂喷洒;对照组仅给予常规透析护理。采用彩色多普勒超声分别于研究开始时、研究后6个月、研究后1年检测自体动静脉瘘口的血流量,记录为Qa0、Qa1、Qa2;比较三组患者不同时间点动静脉瘘口血流量变化,同时观察三组患者动静脉瘘出现并发症情况。结果研究1年后,远红外线组与联合治疗组患者Qa1、Qa2显著高于Qa0,差异具有统计学意义(P<0.05);对照组患者Qa0、Qa1、Qa2之间差异无统计学意义(P>0.05);组间比较,联合治疗组Δ(Qa1-Qa0)、Δ(Qa2-Qa0)显著高于对照组与远红外线组(P<0.05);远红外线组Δ(Qa1-Qa0)、Δ(Qa2-Qa0)显著高于对照组(P<0.05);并发症方面,联合治疗组与远红外线组并发症发生率明显低于对照组(9.09%vs13.63%vs27.27%),差异具有统计学意义(P<0.05)。结论采用自体动静脉瘘维持血液透析的尿毒症患者应用壳聚糖联合远红外线能够有效提高自体动静脉瘘血管流量,降低动静脉瘘并发症,值得临床护理推广应用。

Objective To explore the effect of combined treatment of chitosan and far-infrared ray in improving the bloodflow of arteriovenous fistula.Methods66patients with uremia underwent hemodialysis with autologous arteriovenousfistula in Hemodialysis room of our hospital from January2015to February2016were slelected and divided into far infraredgroup,chitosan and far infrared combined treatment group and control group with22cases in each according to randomdigigtal table method.Patients in far infrared group were treated with radiation at the arteriovenous fistula at the beginningof dialysis,each time40min.Patients in chitosan and far infrared combined treatment group were treated with chitosansprays at the arteriovenous fistula before irradiation with far infrared rays,and patients in control group were treated withroutine dialysis care.At the beginning of the study,6months after the study and1years after the study,color Dopplerultrasonography was used to measure the mouth of an arteriovenous fistula as Qa0,Qa1and Qa2,to compared blood flowof arteriovenous fistula at different time points in three groups and oberve the complications of arteriovenous fistula in thethree groups.Results After1years,the Qa1and Qa2in the far infrared group and the combined treatment group weresignificantly higher than those in the Qa0group,and the difference was statistically significant(P<0.05).The difference ofQa0,Qa1and Qa2between the control group was not statistically significant(P>0.05).Between groups,Δ(Qa1-Qa0)andΔ(Qa2-Qa0)in the combined treatment group were significantly higher than that in the control group and the far infraredgroup,P<0.05.The far infrared ray groupΔ(Qa1-Qa0)andΔ(Qa2-Qa0)were significantly higher than that of thecontrol group(P<0.05).In complication,the complication rate of the combined treatment group and the far infrared groupwas lower than that of the control group(9.09%vs13.63%vs27.27%),the difference was statistically significant(P<0.05).Conclusion Chitosan combined with far infrared ray can effectively improve the blood flow of autologous arteriovenousfistula in patients undergoing hemodialysis with autologous arteriovenous fistula,and reduce complications of arteriovenousfistula.It is worth popularizing in clinical nursing.