术前功能锻炼联合术后远红外线照射对促进糖尿病肾病患者AVF成熟的效果观察

The effect of preoperative functional exercise combined with postoperative far-infrared radiation on promoting AVF maturation in patients with diabetic nephropathy

目的旨在观察术前功能锻炼联合术后远红外线照射对糖尿病肾病(DN)患者自体动静脉内瘘(AVF)术后促成熟的应用效果。方法将研究对象分为对照组和试验组,对照组患者42例,试验组患者46例。对照组接受常规围术期管理,试验组在上述基础上指导术前功能锻炼及术后远红外线照射。比较两组患者一般情况,头静脉、桡动脉干预前后血管内径,手术成功率,成熟期的吻合口血流量、头静脉内径及管厚度,AVF成熟时间,术后半年内有无并发症。结果术前运动60 d后,试验组头静脉内径[(2.18±0.33)mm]及桡动脉内径[(1.84±0.24)mm],大于对照组的[(1.99±0.28)mm vs.(1.78±0.27)mm],差异有统计学意义(P<0.05);试验组AVF成熟时间(80.35±7.85)d,小于对照组的(89.23±6.73)d(P<0.01);试验组成熟期头静脉内径(5.01±0.44)mm,大于对照组的(4.82±0.51)mm(P<0.05),头静脉管壁厚度(0.84±0.07)mm,大于对照组的(0.81±0.08)mm,但两组比较差异无统计学意义(P>0.05);试验组成熟期吻合口血流量(598.16±66.62)mL/min,高于对照组的(525.12±53.91)mL/min(P<0.01);术后半年内对照组并发症发生率26.09%,高于试验组的6.52%(P<0.05)。结论术前功能锻炼联合远红外照射能缩短DN患者动静脉AVF成熟的时间,增加吻合口血流量,减少术后半年AVF并发症的发生。

Objective To observe the effect of preoperative functional exercise combined with postoperative far-infrared radiation on the postoperative maturation promotion of artcriovcnous fistula(AVF)in patients with diabetic nephropathy(DN).Methods The study subjects were randomly divided into the control group(n=42)and the test group(n=46).The control group received routine perioperative management.The test group was guided by preoperative functional exercises and postoperative far-infrared irradiation on the basis of the above.The following parameters of the two groups were compared,including the general conditions,the inner diameter before and after exercise of the cephalic vein and radial artery,the success rate of the operation,and the parameters of the internal fistula in mature stage(including the anastomotic blood flow,the internal diameter and the vessel wall thickness of the cephalic vein),the AVF maturity time and the complications within six months after the operation were also compared.Results After 60 days of preoperative exercise,the inner diameter of the cephalic vein in the test group was(2.18±0.33)mm,which was larger than that in the control group[(1.99±0.28)mm,(P<0.05)],and the inner diameter of radial artery in the test group was(1.84±0.24)mm,which was larger than that in the control group[(1.78±0.27)mm,(P<0.05)];The AVF maturity time in the test group was(80.35±7.85)days,which was less than that of the control group[(89.23±6.73)days,P<0.01];the internal diameter of the cephalic vein in mature stage of the test group was(5.01±0.44)mm,which was larger than that of the control group[(4.82±0.51)mm,P<0.05],the cephalic vein wall thickness in the test group was(0.84±0.07)mm,which was larger than that in the control group[(0.81±0.08)mm,P>0.05];the anastomotic blood flow in the test group was(598.16±66.62)mL/min,which was hihger than that in the control group[(525.12±53.91)mL/min,P<0.01];The complication rate within half a year after surgery in the control group was 26.09%,which was hihger than that in the test group(6.52%),P<0.05.Conclusion Preoperative functional exercise combined with far-infrared radiation can shorten the maturation time of the AVF in DN patients,increase the blood flow of the anastomosis,and reduce the occurrence of complications of AVF within half a year after surgery.