乙酰半胱氨酸预防自体动静脉内瘘早期狭窄 的临床观察

Clinical observation of acetylcysteine for prevention of early stenosis in autologous arteriovenous fistulas

目的探讨乙酰半胱氨酸预防自体动静脉内瘘早期狭窄的临床疗效。方法选取2018年5月至2020年4月间,于九江市第一人民医院首次建立自体动静脉内瘘的70例尿毒症患者,随机分成观察组(n=35例)和对照组(n=35例)。观察组在常规治疗尿毒症药物的基础上采用口服乙酰半胱氨酸(0.6g,bid)治疗,对照组采用常规尿毒症治疗药物。于内瘘术前、术后1个月和术后3个月时间点采集外周空腹静脉血并行内瘘彩超加以评估。在检测后对患者的结果进行评估,比较两组患者TGF-β和CRP等相关指标的差异。结果治疗后,观察组术后3个月时TGF-β、CRP均显著低于对照组(P<0.05);观察组的内瘘成熟、狭窄发生率数均低于对照组(P<0.05)。结论使用乙酰半胱氨酸预防自体动静脉内瘘早期狭窄,可在一定程度上降低内瘘早期狭窄、失功率,抑制自体内瘘内膜的增生,潜在促进患者内瘘成熟,值得进一步深入研究。

Objective To explore the clinical effection of acetylcysteine in preventing early stenosis of autogenous arteriovenous fistula.Methods From May 2018 to April 2020,70 cases of uremic patients with autogenous arteriovenous fistula were first established in our hospital and randomly divided into observation group(n=35 cases)and control group(n=35 cases).In the observation group,oral acetylcysteine(0.6g bid)was used in addition to conventional uremic medications,and control group was treated with conventional uremic medications.Peripheral fasting venous blood was collected preoperatively,1 month postoperatively,and 3 month postoperatively,and the fistula was evaluated with color ultrasound.After the test,the results of the patients were evaluated.The TGF-β,CRP and other related indicators were compared between the two groups.Results TGF-βand CRP were significantly lower in the observation group than those in control group at the third month postoperatively(P<0.05).The incidences of endovenous fistula maturation and stenosis were lower in the observation group than in the control group(P<0.05).Conclusion The use of acetylcysteine to prevent early stenosis of autologous arteriovenous fistula can reduce early stenosis and loss of power,and inhibit the proliferation of fistula lining in autologous body,and potentially promote fistula maturation,which deserves further in-depth study.