慢性肾衰中医证型与动静脉内瘘相关性分析研究

Study on effect of arteriovenous fistuloplasty on chronic renal failure patients with different traditional Chinese medicine syndromes

目的 探究动静脉内瘘成形术对不同中医证型慢性肾衰患者的效果。方法 180例不同中医证型慢性肾衰患者,均进行动静脉内瘘成形术治疗。比较正虚证和标实证不同分型患者动静脉内瘘术后情况及手术前后正虚证和标实证不同分型患者的内瘘血管直径、内瘘血流量。结果 术前及术后6个月、1年,脾肾气虚证内瘘血管直径分别为(6.92±0.53)、(6.42±0.42)、(6.29±0.45)mm,脾肾阳虚证分别为(6.95±0.54)、(6.53±0.45)、(6.22±0.42)mm,肝肾阴虚证分别为(6.89±0.51)、(6.83±0.46)、(6.78±0.39)mm,气阴两虚证分别为(6.93±0.52)、(6.86±0.43)、(6.75±0.41)mm,阴阳两虚证分别为(6.91±0.50)、(6.85±0.44)、(6.78±0.38)mm。术前及术后6个月、1年,脾肾气虚证内瘘血流量分别为(632.63±21.50)、(577.63±20.55)、(565.47±13.35)ml/min,脾肾阳虚证分别为(631.51±26.51)、(575.29±20.68)、(563.59±13.41)ml/min,肝肾阴虚证分别为(633.49±27.19)、(625.55±26.69)、(621.68±26.31)ml/min,气阴两虚证分别为(632.75±27.33)、(625.67±25.88)、(620.58±25.59)ml/min,阴阳两虚证分别为(631.58±26.96)、(623.71±26.37)、(619.65±26.51)ml/min。术前,脾肾气虚证、脾肾阳虚证、肝肾阴虚证、气阴两虚证、阴阳两虚证的内瘘血管直径和内瘘血流量比较差异无统计学意义(P>0.05);术后6个月及术后1年,脾肾气虚证与脾肾阳虚证的内瘘血管直径和内瘘血流量均显著小于肝肾阴虚证、气阴两虚证、阴阳两虚证,差异具有统计学意义(P<0.05)。术前及术后6个月、1年,水湿证内瘘血管直径分别为(6.90±0.56)、(6.73±0.45)、(6.32±0.42)mm,湿热证分别为(6.93±0.52)、(6.76±0.47)、(6.30±0.41)mm,血瘀证分别为(6.92±0.55)、(6.39±0.41)、(6.10±0.38)mm,溺毒证分别为(6.95±0.53)、(6.79±0.46)、(6.35±0.44)mm。术前及术后6个月、1年,水湿证内瘘血流量分别为(632.68±25.42)、(611.49±25.39)、(606.43±24.08)ml/min,湿热证分别为(630.22±26.08)、(613.58±26.11)、(608.69±25.69)ml/min,血瘀证分别为(632.87±25.71)、(570.63±23.42)、(554.69±22.68)ml/min,溺毒证分别为(629.19±26.19)、(604.75±25.49)、(602.75±24.75)ml/min。术前,水湿证、湿热证、血瘀证、溺毒证的内瘘血管直径和内瘘血流量比较差异无统计学意义(P>0.05);术后6个月及术后1年,血瘀证内瘘血管直径和内瘘血流量均显著小于水湿证、湿热证、溺毒证,差异具有统计学意义(P<0.05)。脾肾气虚证的动静脉内瘘成熟率为72.55%,脾肾阳虚证的动静脉内瘘成熟率为71.43%,均低于肝肾阴虚证的97.50%、气阴两虚证的97.14%、阴阳两虚证的100.00%,差异具有统计学意义(P<0.05);术后6个月,脾肾气虚证的动静脉内瘘失功率为29.41%,脾肾阳虚证的动静脉内瘘失功率为28.57%,均高于肝肾阴虚证的0、气阴两虚证的2.86%、阴阳两虚证的0,差异具有统计学意义(P<0.05);术后1年,脾肾气虚证的动静脉内瘘失功率为33.33%,脾肾阳虚证的动静脉内瘘失功率为35.71%,均高于肝肾阴虚证的2.50%、气阴两虚证的5.71%、阴阳两虚证的0,差异具有统计学意义(P<0.05)。血瘀证动静脉内瘘成熟率72.55%低于水湿证的95.92%、湿热证的96.15%、溺毒证的92.86%,差异具有统计学意义(P<0.05);术后6个月,血瘀证动静脉内瘘失功率19.61%高于水湿证的2.04%、湿热证的0、溺毒证的3.57%,差异具有统计学意义(P<0.05);术后1年,血瘀证动静脉内瘘失功率23.53%高于水湿证的4.08%、湿热证的1.92%、溺毒证的3.57%,差异具有统计学意义(P<0.05)。结论 在慢性肾衰患者中,脾肾气虚证、脾肾阳虚证、血瘀证的动静脉内瘘成熟率低,内瘘失功率高,应当加强干预措施促进动静脉内瘘成熟以及保护动静脉内瘘功能。

Objective To investigate the effect of arteriovenous fistuloplasty on chronic renal failure patients with different traditional Chinese medicine syndromes.Methods There were 180 patients with different traditional Chinese medicine syndromes of chronic renal failure,and all were treated with arteriovenous fistuloplasty.The postoperative condition of arteriovenous fistula in patients with different traditional Chinese medicine syndromes,and the vessel diameter and blood flow of internal fistula in patients with different traditional Chinese medicine syndromes before and after surgery were compared.Results Preoperatively and 6 months and 1 year postoperatively,the vessel diameters of internal fistula were(6.92±0.53),(6.42±0.42),and(6.29±0.45)mm for patients with spleen-kidney qi deficiency syndrome,(6.95±0.54),(6.53±0.45),and(6.22±0.42)mm for patients with spleen-kidney yang deficiency syndrome,(6.89±0.51),(6.83±0.46),and(6.78±0.39)mm for patients with yin deficiency of liver and kidney syndrome,(6.93±0.52),(6.86±0.43),and(6.75±0.41)mm for patients with qi-yin deficiency syndrome,and(6.91±0.50),(6.85±0.44),and(6.78±0.38)mm for patients with yin-yang deficiency syndrome.Preoperatively and 6 months and 1 year postoperatively,the blood flow of internal fistula were(632.63±21.50),(577.63±20.55),(565.47±13.35)ml/min for patients with spleen-kidney qi deficiency syndrome,(631.51±26.51),(575.29±20.68),(563.59±13.41)ml/min for patients with spleen-kidney yang deficiency syndrome,(633.49±27.19),(625.55±26.69),(621.68±26.31)ml/min for patients with yin deficiency of liver and kidney syndrome,(632.75±27.33),(625.67±25.88),(620.58±25.59)ml/min for patients with qi-yin deficiency syndrome,and(631.58±26.96),(632.71±26.37),(619.65±26.51)ml/min for patients with yin-yang deficiency syndrome,respectively.Preoperatively,the diameter and blood flow of the internal fistula among patients with spleen-kidney qi deficiency syndrome,spleen-kidney yang deficiency syndrome,yin deficiency of liver and kidney syndrome,qi-yin deficiency syndrome and yin-yang deficiency syndrome were compared,and the differences were not statistically significant(P>0.05).At 6 months and 1 year postoperatively,the diameter and blood flow of the internal fistula of patients with spleen-kidney qi deficiency syndrome and spleen-kidney yang deficiency syndrome were significantly less than those of patients with yin deficiency of liver and kidney syndrome,qi-yin deficiency syndrome,and yin-yang deficiency syndrome,and the differences were statistically significant(P<0.05).Preoperatively and 6 months and 1 year postoperatively,the diameter of internal fistula were(6.90±0.56),(6.73±0.45),and(6.32±0.42)mm for patients with water-damp syndrome,(6.93±0.52),(6.76±0.47),and(6.30±0.41)mm for patients with damp-heat syndrome,(6.92±0.55),(6.39±0.41),and(6.10±0.38)mm for patients with blood stasis syndrome,and(6.95±0.53),(6.79±0.46),and(6.35±0.44)mm for patients with drowning syndrome.Preoperatively and 6 months and 1 year postoperatively,the blood flow of internal fistula were(632.68±25.42),(611.49±25.39),and(606.43±24.08)ml/min for patients with water-damp syndrome,(630.22±26.08),(613.58±26.11),and(608.69±25.69)ml/min for patients with damp-heat syndrome,(632.87±25.71),(570.63±23.42),and(554.69±22.68)ml/min for patients with blood stasis syndrome,and(629.19±26.19),(604.75±25.49),and(602.75±24.75)ml/min for patients with drowning syndrome.Preoperatively,the diameter and blood flow of internal fistula of patients with water-damp syndrome,damp-heat syndrome,blood stasis syndrome and drowning syndrome were compared,and the differences were statistically significant(P>0.05).At 6 months and 1 year postoperatively,the diameter and blood flow of internal fistula of patients with blood stasis syndrome were significantly less than those of patients with water-damp syndrome,damp-heat syndrome and drowning syndrome,and the differences were statistically significant(P<0.05).The maturation rate of the arteriovenous fistula of patients with spleen-kidney qi deficiency syndrome and spleen-kidney yang deficiency syndrome were 72.55%and 71.43%,which were lower than 97.50%,97.41%and 100.00%of patients with yin deficiency of liver and kidney syndrome,qi-yin deficiency syndrome and yin-yang deficiency syndrome,and the differences were statistically significant(P<0.05).At 6 months postoperatively,the failure rate of the arteriovenous fistula of patients with spleen-kidney qi deficiency syndrome and spleen-kidney yang deficiency syndrome were 29.41%and 28.57%,which were lower than 0,2.86%and 0 of patients with yin deficiency of liver and kidney syndrome,qi-yin deficiency syndrome and yin-yang deficiency syndrome,and the differences were statistically significant(P<0.05).At 1 year postoperatively,the failure rate of the arteriovenous fistula of patients with spleen-kidney qi deficiency syndrome and spleen-kidney yang deficiency syndrome were 33.33%and 35.71%,which were higher than 2.50%,5.71%and 0 of patients with yin deficiency of liver and kidney syndrome,qi-yin deficiency syndrome and yin-yang deficiency syndrome,and the differences were statistically significant(P<0.05).The maturation rate of the arteriovenous fistula of patients with blood stasis syndrome was 72.55%,which was lower than 95.92%of patients with water-damp syndrome,96.15%of patients with damp-heat syndrome,and 92.86%of patients with drowning syndrome,and the differences were statistically significant(P<0.05).At 6 months postoperatively,the failure rate of the arteriovenous fistula of patients with blood stasis syndrome was 16.61%,which was higher than 2.04%of patients with water-damp syndrome,0 of patients with damp-heat syndrome,and 3.57%of patients with drowning syndrome,and the differences were statistically significant(P<0.05).At 1 year postoperatively,the failure rate of the arteriovenous fistula of patients with blood stasis syndrome was 23.53%,which was higher than 4.08%of patients with water-damp syndrome,1.92%of patients with damp-heat syndrome,and 3.57%of patients with drowning syndrome,and the differences were statistically significant(P<0.05).Conclusion In patients with chronic renal failure,the maturation rate of the arteriovenous fistula is low in patients with spleen-kidney qi deficiency syndrome,spleen-kidney yang deficiency syndrome and blood stasis syndrome,and the failure rate of internal fistula is high.Intervention measures should be strengthened to promote the maturation of arteriovenous fistula and protect the intravenous fistula function.