中药熏洗联合如意金黄散外敷对血液透析自体动静脉内瘘维护效果的临床研究

Clinical Study on Maintenance Effect of Chinese Herbal Fumigation and Washing Combined with External Application of Ruyi Jinhuang Powder on Autologous Arteriovenous Fistula in Hemodialysis Patients

目的:观察中药熏洗联合如意金黄散外敷对血液透析自体动静脉内瘘(AVF)的维护效果。方法:将120例维持性血液透析自体AVF患者随机分为对照组和观察组各60例。对照组采用喜疗妥软膏外涂联合医用远红外线电磁波(TDP)治疗仪照射,观察组采用中药熏洗联合如意金黄散外敷,均于透析间隔期进行干预。连续观察6个月。以彩色多普勒超声测量患者治疗前后AVF的内瘘管径、内瘘血流量、透析中血流量;评价治疗后的内瘘血管弹性,记录血管狭窄、血栓形成、管腔闭塞、皮肤周围硬结、斑点及瘀血等并发症的发生情况。结果:干预后,观察组血管弹性优于对照组,差异有统计学意义(P <0.05)。2组内瘘管径均较干预前变小(P <0.05),内瘘血流量、透析中血流量均较干预前下降(P <0.05)。观察组内瘘管径大于对照组(P <0.05),内瘘血流量、透析中血流量均多于对照组(P <0.05)。2组血管狭窄、血栓形成、管腔闭塞、皮肤周围硬结的发生率比较,差异均无统计学意义(P> 0.05)。观察组斑点及瘀血的发生率11.67%,低于对照组的30.00%(P <0.05);观察组并发症累积发生率36.67%,低于对照组的78.33%(P <0.01)。结论:中药熏洗联合如意金黄散外敷能有效改善AVF血管弹性,起到维护AVF的作用,并能减少并发症的发生。

Objective: To observe the maintenance effect of Chinese herbal fumigation and washing combined with external application of Ruyi Jinhuang powder on autologous arteriovenous fistula(AVF) in hemodialysis patients. Methods:A total of 120 cases of maintenance hemodialysis patients with autologous AVF were randomly divided into the control group and the observation group,60 cases in each group. The control group was given external application of hirudoid cream and Te-Ding Dian-ci-bo Pu(TDP) therapeutic instrument, and the observation group was given Chinese herbal fumigation and washing combined with external application of Ruyi Jinhuang powder. Both groups were given intervention during dialysis interval,and were treated and observed for six months. The diameters of internal fistula,the blood flow in internal fistula and the one during dialysis in autologous AVF before and after treatment were measured by color Doppler ultrasound;the vascular elasticity of internal fistula after treatment was evaluated;the incidence of complications such as vascular stenosis,thrombosis, obliteration, induration in the surrounding skin, spots and blood stasis was recorded. Results: After intervention,the vascular elasticity in the observation group was better than that in the control group,the difference being significant(P < 0.05). The diameters of internal fistula in the two groups were decreased when compared with those before intervention(P < 0.05);the blood flow in internal fistula and the one during dialysis were decreased when compared with those before intervention(P < 0.05). The diameter of internal fistula in the observation group was larger than that in the control group(P < 0.05);the blood flow in internal fistula and the one during dialysis in the observation group were larger than those in the control group(P < 0.05). Compared the incidence of vascular stenosis, thrombosis, obliteration and induration in the surrounding skin in the two groups,there was no significance in the difference(P > 0.05). The incidence of spots and blood stasis was 11.67% in the observation group, lower than that of 30.00% in the control group(P < 0.05);the cumulative incidence of complications was 36.67% in the observation group,lower than that of 78.33% in the control group(P < 0.01).Conclusion: The therapy of Chinese herbal fumigation and washing combined with external application of Ruyi Jinhuang powder can effectively improve the vascular elasticity of autologous AVF,maintain its function and reduce the incidence of complications.