土黄连水剂外敷在MHD患者Ⅰ型内瘘狭窄开放手术后的应用效果

Application Effect of External Application of Tuhuanglian Aqueous Solution after Open Surgery in MHD Patients with TypeⅠInternal Fistula Stenosis

目的:评价土黄连水剂外敷在维持性血液透析(MHD)患者Ⅰ型内瘘狭窄开放手术后的应用效果。方法:选取2019年4月—2021年5月桂林市中医医院收治的120例MHD期间因自体血管内瘘出现Ⅰ型狭窄而行开放手术治疗者为研究对象,根据随机数字表法分为对照组(n=60)和观察组(n=60)。对照组术后给予莫匹罗星软膏治疗,观察组术后则给予土黄连水剂外敷治疗。比较两组尿素清除率(URR)、尿素清除指数(Kt/V)、血常规、血栓相关因子水平及内瘘血管内径、血流量,统计两组半年内内瘘再狭窄率及并发症发生率。结果:治疗7 d后,两组URR、Kt/V均较治疗前明显升高,C反应蛋白(CRP)、白细胞计数(WBC)、中性粒细胞百分比(N%)、纤维蛋白原(FIB)、D-二聚体(D-D)均较治疗前明显下降,且观察组血栓相关因子(FIB、D-D)和CRP均明显低于对照组(P<0.05);治疗7 d后,两组URR、Kt/V、WBC、N%比较,差异均无统计学意义(P>0.05)。治疗2周后,两组内瘘血管内径、血流量均较治疗前明显升高,且观察组内瘘血管内径、血流量均明显高于对照组,差异均有统计学意义(P<0.05)。两组半年内内瘘再狭窄率及并发症发生率比较,差异均无统计学意义(P>0.05)。结论:土黄连水剂外敷可有效改善MHD期间Ⅰ型内瘘狭窄开放手术后患者内瘘血管内径、血流量,并且可抑制患者炎症反应,防止血栓形成。

Objective:To evaluate the application effect of external application of Tuhuanglian Aqueous Solution after open surgery in maintenance hemodialysis(MHD)patients with typeⅠinternal fistula stenosis.Method:A total of 120 patients admitted to Guilin Municipal Hospital of Traditional Chinese Medicine from April 2019 to May 2021 who underwent open surgery for typeⅠstenosis of autologous vascular fistula during MHD were selected as the study objects,and were divided into control group(n=60)and observation group(n=60)according to random number table method.The control group was treated with Mupirocin Ointment after surgery,and the observation group was treated with external application of Tuhuanglian Aqueous Solution.Urea clearance ratio(URR),urea clearance index(Kt/V),blood routine,thrombus-related factors levels,internal fistula vessel diameter and blood flow were compared between the two groups,and the fistula restenosis rate within six months and complication rate were analyzed.Result:After 7 days of treatment,URR and Kt/V in both groups were significantly higher than those before treatment,C reactive protein(CRP),white blood cell count(WBC),neutrophil percentage(N%),fibrinogen(FIB)and D-dimer(D-D)were significantly lower than those before treatment,and thrombus-related factors(FIB,D-D)and CRP in the observation group were significantly lower than those in the control group(P<0.05).After 7 days of treatment,there were no significant differences in URR,Kt/V,WBC and N%between the two groups(P>0.05).After 2 weeks of treatment,the vessel diameter and blood flow of internal fistula in both groups were significantly higher than those before treatment,and the vessel diameter and blood flow of internal fistula in the observation group were significantly higher than those in the control group,the differences were statistically significant(P<0.05).There were no significant differences in fistula restenosis rate within six months and complication rate between the two groups(P>0.05).Conclusion:External application of Tuhuanglian Aqueous Solution can effectively improve the vessel diameter and blood flow of internal fistula in patients after open surgery for typeⅠinternal fistula stenosis during MHD,and can inhibit the inflammatory response of patients and prevent thrombosis.