中药湿热敷对维持性血液透析患者自体动静脉内瘘功能、并发症及生活质量的影响

Effect of Hot-Wet Application with Chinese Medicine on Autologous Arteriovenous Fistula Function,Complications and Quality of Life in Patients Undergoing Maintenance Hemodialysis

目的:观察采用中药湿热敷对维持性血液透析患者自体动静脉内瘘(AVF)功能、并发症及生活质量的影响。方法:选取80例慢性肾脏病伴维持性血液透析患者,按随机数字表法分为观察组及对照组各40例。2组均行自体动静脉造瘘术,对照组给予常规AVF围手术期护理,观察组给予常规AVF围手术期护理加用中药湿热敷,2组均治疗4周。比较2组临床疗效,比较2组治疗前后内瘘血流量、瘘口内径、生活质量[日常生活活动能力(ADL)评分、Spiegel量表评分]的变化,观察2组治疗后并发症发生情况。结果:治疗4周后,观察组临床疗效总有效率为87.50%,对照组为67.50%,2组比较,差异有统计学意义(P<0.05)。治疗4周后,2组内瘘血流量及瘘口内径均较治疗前增加,差异均有统计学意义(P<0.05);治疗4周后,观察组内瘘血流量高于对照组,差异有统计学意义(P<0.05);治疗4周后2组瘘口内径比较,差异无统计学意义(P>0.05)。治疗4周后,观察组AVF狭窄、皮肤硬结发生率均低于对照组,差异均有统计学意义(P<0.05);2组瘤样扩张、皮肤瘀斑发生率比较,差异均无统计学意义(P>0.05)。治疗4周后,2组ADL、Spiegel量表评分均较治疗前下降,观察组ADL、Spiegel量表评分均低于对照组,差异均有统计学意义(P<0.05)。结论:中药湿热敷疗法对维持性血液透析患者疗效较好,能促进AVF成熟,改善AVF功能,减少并发症,提高患者生活质量。

Objective:To observe the effect of hot-wet application with Chinese medicine on autologous arteriovenous fistula(AVF)function,complications and quality of life in patients undergoing maintenance hemodialysis.Methods:A total of 80 cases of patients who had chronic kidney disease and were undergoing maintenance hemodialysis were selected and divided into the observation group and the control group according to the random number table method,with 40 cases in each group.Both groups were given surgery of autologous arteriovenous fistula;the control group was given routine perioperative nursing of AVF,and the observation group was additionally treated with hot-wet application with Chinese medicine based on the treatment of the control group.Both groups were treated for four weeks.Clinical effects were compared between the two groups.The changes in internal fistula blood flow,fistula diameter and quality of life including scores of Activities of Daily Living(ADL)and Spiegel Scale were compared between the two groups before and after treatment.The incidence of complications after treatment was observed in the two groups.Results:After four-week treatment,the total effective rate of clinical effect was 87.50%in the observation group and 67.50%in the control group,the difference being significant(P<0.05).After four-week treatment,internal fistula blood flow and fistula diameter in the two groups were increased when compared with those before treatment,differences being significant(P<0.05);internal fistula blood flow in the observation group was higher than that in the control group,the difference being significant(P<0.05);there was no significant difference being found in the comparison of fistula diameter between the two groups(P>0.05).After four-week treatment,the incidences of AVF stenosis and skin induration in the observation group were lower than those in the control group,differences being significant(P<0.05);there was no significant difference being found in the comparison of incidences of tumor-like expansion and skin ecchymosis between the two groups(P>0.05).After four-week treatment,scores of ADL and Spiegel Scale in the two groups were decreased when compared with those before treatment,and the two scores in the observation group were lower than those in the control group,differences being significant(P<0.05).Conclusion:Hot-wet application with Chinese medicine has a good curative effect on patients undergoing maintenance hemodialysis,and can promote the maturity of AVF,improve the function of AVF,reduce complications and enhance the quality of life of patients.