活血止痛外敷方治疗血液透析患者动静脉内瘘功能不良的疗效及安全性研究

Study on Efficacy and Safety of Using Huoxue Zhitong External Application Rcipe in the Treatment of Arteriove⁃nous Fistula Dysfunction in Patients with Hemodialysis

目的:观察活血止痛外敷方对血液透析患者自体动静脉内瘘(AVF)功能不良的治疗效果。方法:选取2019年1月-2020年12月到我院就诊的阳虚血瘀型AVF功能不良患者86例,采用随机数字表法将其分为研究组和对照组各43例。对照组给予远红外线照射治疗,研究组在对照组的基础上采用活血止痛外敷方联合治疗。比较两组患者治疗前及治疗8周时的中医症候积分、内瘘血管恢复状态(内瘘血流量、内瘘直径、血管弹性状况、血管杂音状况)、凝血功能指标[纤维蛋白原(FIB)、D-二聚体(DD)、凝血酶原时间(PT)]及血清炎症因子[超敏C反应蛋白(hs-CRP)、肿瘤坏死因子(TNF-α)、白细胞介素18(IL-18)]含量变化;比较两组治疗8周期间的不良反应及跟踪随访1年时的失功或再造率。结果:治疗8周时,两组中医症候(畏寒怕冷、四肢发凉、神疲乏力、虚喘气短)积分、内瘘血管恢复状态(内瘘血流量、内瘘直径、血管弹性状况、血管杂音状况)及血清炎症因子(hs-CRP、TNF-α、IL-18)水平较治疗前均明显改善,且研究组显著优于对照组(P均<0.05);两组血清FIB、DD含量及PT指数于治疗8周时明显降低,但研究组与对照组间无显著差异(P均>0.05);研究组治疗8周期间不良反应发生情况及1年内动静脉内瘘失功或再造率显著低于对照组(P均<0.05)。结论:活血止痛外敷方对治疗阳虚血瘀型慢性肾病患者的AVF功能不良症状不仅效果良好,且安全性高。

Objective: To explore the therapeutic effect of using Huoxue Zhitong External Application Recipe on autogenous arteriovenous fistula(AVF) dysfunction in patients with hemodialysis. Methods: A total of 86 patients with AVF dysfunction of Yang-deficiency and blood-stasis syndrome who came to our hospital from January 2019 to October 2020 were selected and divided into a study group and a controlled group according to the random number table method, with 43 cases in each group. The controlled group was given far-infrared radiation treatment, and the study group was combined with Huoxue Zhitong External Application Recipe on the basis of the controlled group. The TCM syndromes scores, internal fistula vascular recovery status(internal fistula blood flow, internal fistula diameter, vascular elasticity status, vascular murmur status),coagulation function indexes [fibrinogen(FIB),D-dimer(DD),prothrombin time(PT)] and serum inflammatory factors [high-sensitivity C-reactive protein(hs-CRP),tumor necrosis factor(TNF-α),interleukin 18(IL-18)] were compared between the two groups before treatment and at 8 weeks of treatment. The adverse reactions during 8 weeks of treatment and dysfunction rate or reconstruction rate during 1 year of follow-up were compared between the two groups. Results: At 8 weeks of treatment, the scores of TCM symptoms(cold intolerance, coolness extremities, fatigue, shortness of breath),internal fistula vascular recovery status(internal fistula blood flow, internal fistula diameter, vascular elasticity status, vascular murmur status) and levels of serum inflammatory factors(hs-CRP,TNF-α,IL-18) in the two groups were significantly improved compared with those before treatment, and the above indicators of the study group were significantly better than those of the controlled group(all P<0.05). The levels of serum FIB and DD and PT index in the two groups were significantly reduced at 8 weeks of treatment, but there were no significant differences between the study group and the controlled group(P>0.05). The occurrence of adverse reactions during 8 weeks of treatment and dysfunction rate or reconstruction rate of arteriovenous fistula within 1 year in the study group were significantly lower than those in the controlled group(all P<0.05). Conclusion: Huoxue Zhitong External Application Recipe has a good effect and high safety in the treatment of AVF dysfunction symptoms in patients with chronic kidney disease of Yang-deficiency and blood-stasis syndrome.