健瘘方热敷联合阿司匹林肠溶片对尿毒症自体动静脉内瘘成形术后患者内瘘功能的影响

Effect of hot compress therapy of Jianlou Recipe combined with aspirin enteric-coated tablets on internal fistula function in uremia patients with arteriovenous fistulaplasty

目的观察健瘘方热敷联合阿司匹林肠溶片对尿毒症自体动静脉内瘘成形术(AVF)后患者内瘘功能的影响。方法选择2019年7月至2021年7月收治的80例尿毒症AVF后患者为研究对象,按照随机数字表法分为2组,对照组40例予阿司匹林肠溶片治疗,治疗组40例在对照组基础上联合健瘘方热敷治疗。2组均治疗1个月比较2组治疗前及治疗1、2、3、4周内瘘血流量、内瘘内径及血管内皮功能指标[包括内皮素-1(ET-1)及一氧化氮(NO)]水平变化情况,比较2组治疗期间血管弹性、血管杂音、内瘘通畅率及并发症发生情况,2组治疗结束后均随访1年,统计内瘘失功或再造情况。结果与本组治疗前比较,2组治疗1、2、3、4周内瘘血流量及内瘘内径均增加(P<0.05),且治疗组治疗1、2、3、4周内瘘血流量及内瘘内径均大于对照组(P<0.05)。与本组治疗前比较,2组治疗1、2、3、4周血管内皮功能指标ET-1水平均降低(P<0.05),NO水平均升高(P<0.05),且治疗组治疗1、2、3、4周ET-1水平低于对照组(P<0.05),NO水平高于对照组(P<0.05)。治疗组血管弹性好率92.50%(37/40),血管杂音弱率90.00%(36/40)),对照组血管弹性好率70.00%(28/40),血管杂音弱率72.50%(29/40),治疗组血管弹性好率高于对照组(P<0.05),血管杂音弱率高于对照组(P<0.05)。治疗组内瘘通畅率92.50%(37/40),对照组内瘘通畅率72.50%(29/40),治疗组内漏通畅率高于对照组(P<0.05)。治疗组并发症总发生率2.50%(1/40),对照组并发症总发生率20.00%(8/40),治疗组并发症总发生率低于对照组(P<0.05)。治疗组随访1年内瘘失功或再造率5.00%(2/40),对照组随访1年内瘘失功或再造率25.00%(10/40),治疗组随访1年内瘘失功或再造率低于对照组(P<0.05)。结论健瘘方热敷联合阿司匹林肠溶片治疗尿毒症AVF后患者疗效确切,可有效改善患者内瘘内径,增加动静脉内瘘血流量,增加血管弹性,减少血管杂音,维持内瘘通畅,减少并发症的发生,且远期疗效可靠,其作用机制可能与改善血管内皮细胞功能,预防血栓形成有关。

Objective To observe the effect of hot compress therapy of Jianlou Recipe combined with aspirin enteric-coated tablets on internal fistula function in uremia patients with arteriovenous fistulaplasty(AVF).Methods Eighty uremia patients with AVF admitted from July 2019 to July 2021 were enrolled as the research subjects,theywere randomized1:1 to the control group(aspirin enteric-coated tablets)or the treatment group(hot compress therapy of JianlouRecipeplus aspirin enteric-coated tablets).The therapeutic effects were calculated after 1-month of treatment.Before treatment and on weeks 1,2,3,and 4 of treatment,the fistula blood flow,internal fistula diameter,and vascular endothelial function indicators(including endothelin-1[ET-1],nitric oxide[NO]),vascular elasticity,vascular murmur,patency rate of internal fistula,and incidence of complications were included as comparators between groups.After 1 year of follow-up,the rates of fistula disfunction and reconstructionwereassessed between groups.Results After treatment,the 1-,2-,3-,4-week blood flow and diameter of the internal fistula in the both groups were significantly greater than those before treatment(P<0.05),which was more pronounced in the treatment group than in the control group(P<0.05).Significantlylowerthe 1-,2-,3-,4-week ET-1 and higher NO were detected in the both groups than those before treatment(both P<0.05),the difference in the levels of ET-1 and NO was significant between groups(both P<0.05).The excellent rate of vascular elasticity(92.50%[37/40]vs 70.00%[28/40]and the rate of vascular murmur(90.00%[36/40]vs 72.50%[29/40])in the treatment group were superior to the control group(P<0.05).The patency rate of internal fistula in the treatment group was significantly higher than that of the control group(92.50%[37/40]vs 72.50%[29/40],P<0.05).The total incidence of complications in the treatment group was significantly lower than that of the control group(2.50%[1/40]vs 20.00%[8/40],P<0.05).The rate of fistula disfunction or reconstruction within 1 year of follow-up in the treatment group was significantly lower than that of the control group(5.00%[2/40]vs 25.00%[10/40],P<0.05).Conclusion Hot compress therapy of Jianlou Recipe combined with aspirin enteric-coated tablets has effective in uremia patients with AVF.It can effectively improve the internal fistula diameter,increase the blood flow of arteriovenous fistula,increase vascular elasticity,reduce vascular murmur,maintain the patency of internal fistula,and reduce complications,with a reliable long-term effect.It is capable to prevent thrombosis by improving the indicators of vascular endothelial function.