前列地尔联合罂粟碱对早期自体动静脉内瘘的保护作用研究

Study on protective effect of alprostadil combined with papaverine on early autologous arteriovenous fistula

目的探究前列地尔联合罂粟碱对早期自体动静脉内瘘的保护作用。方法60例早期行自体动静脉内瘘患者,采用计算机随机化分组法分为观察组和对照组,每组30例。观察组应用前列地尔联合罂粟碱治疗,对照组应用罂粟碱联合阿司匹林治疗。比较两组手术前后血液学指标变化、术后临床指标及不良反应发生情况。结果术后第8天,观察组血小板计数(112.36±10.98)×10^(9)/L、血液粘度(2.06±0.42)mPa·s、红细胞聚集数(4.05±0.35)、纤维蛋白原(3.21±0.14)g/L、凝血酶原时间(13.02±2.64)s、活化部分凝血活酶时间(32.69±6.23)s、D-二聚体(3.12±0.42)mg/L;对照组分别为(115.39±10.78)×10^(9)/L、(2.46±0.35)mPa·s、(4.75±0.36)、(4.39±0.52)g/L、(13.68±2.74)s、(32.74±6.10)s、(3.85±0.32)mg/L。观察组血液粘度、红细胞聚集数、纤维蛋白原、D-二聚体均低于对照组,差异有统计学意义(P<0.05)。两组血小板计数、凝血酶原时间、活化部分凝血活酶时间比较,差异无统计学意义(P>0.05)。观察组术后瘘口血流量(852.36±52.30)ml/min、透析血流量(225.69±24.31)ml/min均明显大于对照组的(654.26±64.38)、(189.63±22.25)ml/min,首次透析时间(3.80±0.34)h短于对照组的(5.26±0.42)h,差异有统计学意义(P<0.05)。观察组不良反应发生率3.33%低于对照组的20.00%,差异有统计学意义(P<0.05)。结论选择前列地尔联合罂粟碱可有效起到保护早期自体动静脉内瘘的作用,有助于改善患者术后血液学指标,改善术后临床指标,提高早期动静脉内瘘成功率。

Objective To investigate the protective effect of alprostadil combined with papaverine on early autologous arteriovenous fistula.Methods A total of 60 hospitalized patients with early autogenous arteriovenous fistula were randomly divided into observation group and control group,with 30 cases in each group.The observation group was treated with alprostadil and papaverine,while the control group was treated with papaverine and aspirin.The changes of hematological indexes preoperatively and postoperatively,postoperative clinical indexes and the occurrence of adverse reactions were compared between the two groups.Results On 8th day postoperatively,the observation group had platelet count of(112.36±10.98)×10^(9)/L,blood viscosity of(2.06±0.42)mPa·s,erythrocyte aggregation index of(4.05±0.35),fibrinogen of(3.21±0.14)g/L,prothrombin time of(13.02±2.64)s,activated partial thrombin time of(2.69±6.23)s,and D-dimer of(3.12±0.42)mg/L.The control group had platelet count of(115.39±10.78)×10^(9)/L,blood viscosity of(2.46±0.35)mPa·s,erythrocyte aggregation index of(4.75±0.36),fibrinogen of(4.39±0.52)g/L,prothrombin time of(13.68±2.74)s,activated partial thrombin time of(32.74±6.10)s,and D-dimer of(3.85±0.32)mg/L.The blood viscosity,erythrocyte aggregation index,fibrinogen and D-dimer in the observation group were lower than those in the control group,and the differences were statistically significant(P<0.05).There was no statistically significant difference in platelet count,prothrombin time and activated partial thrombin time between the two groups(P>0.05).The postoperative blood flow of orificium fistulae of(852.36±52.30)ml/min and the dialysis blood flow of(225.69±24.31)ml/min in the observation group were significantly higher than those of(654.26±64.38)and(189.63±22.25)ml/min in the control group;the first dialysis time of(3.80±0.34)h in the observation group was shorter than that of(5.26±0.42)h in the control group;the differences were statistically significant(P<0.05).The incidence of adverse reactions of 3.33%in the observation group was lower than that of 20.00%in the control group,and the difference was statistically significant(P<0.05).Conclusion The selective application of alprostadil and papaverine can effectively protect the early autologous arteriovenous fistula treatment,help to improve the postoperative hematology index,improve postoperative clinical indexes,and improve the success rate of early arteriovenous fistula。