自拟通脉内瘘方外敷促进自体动静脉内瘘成熟的临床疗效观察

Clinical Effect of External Application of Self-designed Tongmai Neilou Prescription in Promoting the Maturation of Autologous Arteriovenous Fistula

目的探讨通脉内瘘方在自体动静脉内瘘(AVF)术后的治疗作用。方法选择2021年6月—2022年6月在重庆市江津区中医院首次行前臂桡动脉-头静脉内瘘成形术的尿毒症受试患者50例,借助SAS统计分析系统,随机分为观察组(25例)和对照组(25例)。观察组与对照组均给予基础治疗:在术后不渗血的情况下,采用阿司匹林肠溶片治疗,阿司匹林不耐受者采用硫酸氢氯吡格雷片治疗,均治疗30 d。手术后14 d开始,每日用术侧手捏锻炼球或橡皮圈多次,3~5 min/次,连续8周。在此基础上,观察组采用自拟通脉内瘘方外敷治疗,4周为1个疗程,连用2个疗程以观察药效。结果术后4周、8周,观察组患者内瘘头静脉内径、内瘘血流量均高于对照组(P<0.01);术后8周,观察组患者内瘘成熟率(96.00%)高于对照组(72.00%,P<0.05);观察组病人术后并发症发生率低于对照组(P<0.05)。结论通脉内瘘方湿敷可增加接受自体AVF术患者的内瘘血流量,缩短内瘘成熟时间,减少手术后并发症的发生,适宜于临床的普及。

Objective To investigate the effect of Tongmai Neilou Prescription in the treatment of patients undergoing the construction of autogenous arteriovenous fistula.Methods Fifty patients with uremia who underwent the first construction of forearm radial-cephalic vein fistula from June 2021 to June 2022 in Chongqing Jiangjin District Hospital of Chinese Medicine were selected and randomly divided into an observation group(n=25)and a control group(n=25)with the help of Statistical Analysis Software(SAS).Both the observation group and the control group were given basic treatment:Enteric-coated aspirin tablets were used to treat patients without bleeding after operation,while for patients with aspirin intolerance,clopidogrel bisulfate tablets were used.The treatment lasted for 30 days.From the 14th day after operation,patients were asked to pinch the exercise ball or rubber band with the hand on the involved side for 3 to 5 minutes each time for 8 consecutive weeks.On this basis,the observation group was given the self-prepared Tongmai Neilou Prescription for external application.The efficacy was observed after 2 consecutive course of treatment,4 weeks as one course of treatment.Results The cephalic vein diameter and fistula blood flow in the observation group were higher than those in the control group at 4 and 8 weeks after operation(P<0.01).The fistula maturation rate(96.00%)in the observation group was higher than that(72.00%)in the control group at 8 weeks after operation(P<0.05).The incidence of postoperative complications in the observation group was lower than that in the control group(P<0.05).Conclusion Tongmai Neilou Prescription wet compress increases the fistula blood flow,shortens the fistula maturation time and reduces the occurrence of postoperative complications in patients undergoing the construction of autogenous arteriovenous fistula,which is suitable for clinical popularization.