本文選題：糖尿病腎病 + 自體動靜脈內(nèi)瘺　； 參考：《中國中西醫(yī)結(jié)合雜志》2017年06期

【摘要】：目的觀察中藥熏蒸配合功能鍛煉在促進(jìn)糖尿病腎病患者自體動靜脈內(nèi)瘺成熟方面的作用。方法 52例糖尿病腎病患者均在慢性腎臟病G4~G5期時建立自體動靜脈內(nèi)瘺,手術(shù)采用同樣的方式,由同一位醫(yī)生完成。將52例患者隨機(jī)分成對照組和治療組,各26例,對照組于術(shù)后1周開始功能鍛煉;治療組于術(shù)后1周開始中藥熏蒸配合功能鍛煉。術(shù)后2周時,用彩色多普勒測量治療組單次中藥熏蒸治療前后橈動脈內(nèi)徑、橈動脈血流量、頭靜脈內(nèi)徑、頭靜脈血流量;術(shù)后4、8、12周用彩色多普勒測量兩組患者頭靜脈內(nèi)徑、頭靜脈血流量;并隨訪內(nèi)瘺使用6個月內(nèi)并發(fā)癥(包括:近吻合口狹窄,硬結(jié),血腫,血栓形成)發(fā)生率及暢通率。結(jié)果與單次中藥熏蒸前比較,治療組單次中藥熏蒸后橈動脈、頭靜脈內(nèi)徑增寬,橈動脈、頭靜脈血流量增多(P0.01)。與對照組比較,治療組在術(shù)后4、8、12周頭靜脈血流量增多,頭靜脈內(nèi)徑增寬,內(nèi)瘺成熟率增高(P0.05)。與本組術(shù)后4周比較,治療組術(shù)后8周頭靜脈血流量增多,內(nèi)徑逐漸增寬(P0.05)。對照組在4、8、12周頭靜脈血流量逐漸增多、內(nèi)徑逐漸增寬(P0.05)。與對照組比較,治療組近吻合口狹窄、硬結(jié)、血腫等并發(fā)癥發(fā)生率降低(P0.05);內(nèi)瘺通暢率雖高,但差異無統(tǒng)計學(xué)意義(P0.05)。結(jié)論中藥熏蒸配合功能鍛煉能促進(jìn)糖尿病患者自體動靜脈內(nèi)瘺發(fā)育成熟,減少內(nèi)瘺使用后的并發(fā)癥,延長內(nèi)瘺的使用壽命。
[Abstract]:Objective to observe the effect of Chinese medicine fumigation combined with functional exercise on the maturation of autogenous arteriovenous fistula in patients with diabetic nephropathy. Methods 52 patients with diabetic nephropathy established autogenous arteriovenous fistula in G4~G5 stage of chronic kidney disease. The operation was done in the same way by the same doctor. 52 patients were randomly divided into control group (n = 26) and treatment group (n = 26). At 2 weeks after operation, the diameter of radial artery, radial artery blood flow, cephalic vein and cephalic vein were measured by color Doppler before and after a single Chinese medicine fumigation, and the internal diameter of cephalic vein was measured by color Doppler in both groups at 812 weeks after operation. The incidence of complications (including proximal anastomotic stenosis, sclerotic knot, hematoma, thrombosis) within 6 months after the use of internal fistula was analyzed. Results compared with that before single Chinese medicine fumigation, the radial artery, radial artery and cephalic vein blood flow increased in the treatment group after single Chinese medicine fumigation. Compared with the control group, the blood flow of the cephalic vein increased, the diameter of the cephalic vein widened and the mature rate of the internal fistula increased in the treatment group at 12 weeks after operation (P 0.05). Compared with 4 weeks after operation, the blood flow of cephalic vein increased and the inner diameter gradually widened in the treatment group at 8 weeks after operation. In the control group, the venous blood flow increased and the inner diameter widened gradually at 12 weeks. Compared with the control group, the incidence of complications such as proximal anastomotic stenosis, hard knot and hematoma in the treatment group was lower than that in the control group (P 0.05), while the patency rate of internal fistula was higher, but the difference was not statistically significant (P 0.05). Conclusion Chinese herbal fumigation combined with functional exercise can promote the development and maturity of autogenous arteriovenous fistula in diabetic patients, reduce the complications and prolong the service life of internal fistula.
【作者單位】： 衢州市中醫(yī)醫(yī)院腎內(nèi)科;
【基金】：基金項目:鐘堅名老中醫(yī)專家傳承工作室(No.GZS2012042)
【分類號】：R587.2;R692.9

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