本文選題：中藥 + 活血化瘀　； 參考：《湖北中醫(yī)藥大學(xué)》2017年碩士論文

【摘要】：目的維持性血液透析(maintenance hemodialysis,MHD)是終末期腎臟病(end-stage renal disease,ESRD)患者最主要的治療方法之一。因此,在血液透析的整個過程中,建立血液透析所需要的長期血管通路就顯得非常重要,血管通路被認為是維持性血液透析患者的“生命線”。目前在國內(nèi)以及國際上,自體動靜脈內(nèi)瘺(autogenous arteriovenous fistula,AVF)都是公認的首選的長期血管通路,但其成熟率偏低成為困擾臨床醫(yī)生的難題。目前,臨床上還沒有真正行之有效地促進AVF成熟的方法。西醫(yī)多采用阿司匹林、雙嘧達莫等抗血小板藥或抗凝血藥等治療措施,但有限的隨機臨床研究并未發(fā)現(xiàn)這些藥物能有效地提高AVF成熟。中醫(yī)藥治療在這方面有自己的特色和優(yōu)勢�；钛鏊幈徽J為能夠使血管擴張,改善微循環(huán),抑制血小板的黏附、聚集和釋放,抑制血栓素合成酶的活性,具有抗血栓形成和溶血栓的作用,另外,還能清除氧自由基,減輕血管內(nèi)皮損傷。在此背景下,我們探討活血化瘀藥是否真正有助于縮短內(nèi)瘺成熟時間,提高內(nèi)瘺成熟率,改善內(nèi)瘺血流量,減少術(shù)后并發(fā)癥發(fā)生率等,以便為臨床實際提供一條新的思路。方法通過計算機,全面系統(tǒng)地檢索知網(wǎng)、萬方、維普等相關(guān)數(shù)據(jù)庫,搜集國內(nèi)2006年1月1日至2016年12月31日公開發(fā)表的關(guān)于活血化瘀藥促進動靜脈內(nèi)瘺成熟的文獻。我們選取的關(guān)鍵詞為“中藥”或“活血化瘀藥”、“動靜脈內(nèi)瘺”或“血管通路”,選擇隨機對照試驗,然后對文獻進行歸納、整理,提取有關(guān)數(shù)據(jù),并采用Cochrane網(wǎng)提供的Review Manager(Rev Man)version 5.2軟件對提取的數(shù)據(jù)進行Meta分析及系統(tǒng)評價。結(jié)果最終共納入15篇符合要求的文獻,把15篇文獻研究列為15個研究項目,共包含臨床隨機對照試驗合計1050例,包含實驗組524例觀察對象,對照組526例。Meta分析結(jié)果:1.關(guān)于內(nèi)瘺成熟時間的比較:各研究合并效應(yīng)量MD=-10.31,95%CI[-13.34,-7.28]。各研究合并后,實驗組和對照組相比,差異具有統(tǒng)計學(xué)意義(Z=6.67,P0.00001),表明實驗組在縮短內(nèi)瘺成熟時間方面優(yōu)于對照組;2.關(guān)于內(nèi)瘺血流量的比較:各研究合并效應(yīng)量MD=57.69,95%CI[36.28,79.10]。各研究合并后,實驗組和對照組相比,差異具有統(tǒng)計學(xué)意義(Z=5.28,P0.00001),表明實驗組在增加內(nèi)瘺血流量方面強于對照組;3.關(guān)于術(shù)后并發(fā)癥發(fā)生率的比較:各研究合并效應(yīng)量OR=0.19,95%CI[0.08,0.42]。各研究合并后,實驗組和對照組相比,差異具有統(tǒng)計學(xué)意義(Z=4.10,P0.0001),表明在降低術(shù)后并發(fā)癥發(fā)生率方面,實驗組優(yōu)于對照組;4.關(guān)于內(nèi)瘺成熟情況的比較:實驗組在術(shù)后4周、6周、8周及12周內(nèi)瘺成熟情況均好于對照組,差異具有統(tǒng)計學(xué)意義(P值分別為0.0006,0.04,0.007,0.0008);5.兩組患者在首次穿刺成功率方面的比較:各研究合并效應(yīng)量OR=5.64,95%CI[1.92,16.55]。各研究合并后,實驗組和對照組相比,差異具有統(tǒng)計學(xué)意義(Z=3.15,P0.002),表明實驗組在首次穿刺成功率方面更高。結(jié)論與西醫(yī)相比,活血化瘀藥在促進動靜脈內(nèi)瘺成熟方面有自己的特色和優(yōu)勢。在終末期腎臟病患者擬行動靜脈內(nèi)瘺手術(shù)術(shù)前、術(shù)后使用活血化瘀類中藥,可大大減少動靜脈內(nèi)瘺成熟時間,增加動靜脈內(nèi)瘺成熟率,增加血液透析時內(nèi)瘺血流量,減少術(shù)后并發(fā)癥發(fā)生率,提升首次穿刺成功率,值得深入研究及臨床推廣。
[Abstract]:Objective maintenance hemodialysis (maintenance hemodialysis, MHD) is one of the most important treatments for patients with end-stage renal disease (ESRD). Therefore, in the whole process of hemodialysis, the establishment of long-term vascular access needed for hemodialysis is very important. Vascular access is considered to be a maintenance hemodialysis. Analysis of the "lifeline" of patients. At present, autogenous arteriovenous fistula (AVF) is generally accepted as the preferred long-term vascular access at home and abroad, but its low maturity has become a difficult problem for the clinicians. At present, there is no real effective method to promote the maturation of AVF. Use of aspirin, dipyridamole and other antiplatelet drugs or anticoagulants, but limited randomized clinical studies have not found that these drugs can effectively improve AVF maturation. Traditional Chinese medicine has its own characteristics and advantages in this regard. Blood activating and stasis removing drugs are considered to be able to make blood Guan Kuozhang, improve microcirculation and inhibit platelet adhesion. Attach, gather and release, inhibit the activity of thromboxane synthase, have antithrombotic formation and thrombolytic effect. In addition, it can also remove oxygen free radicals and reduce vascular endothelial damage. In this context, we explore whether the blood circulation removing drugs really help to shorten the maturity of internal fistula, improve the maturity of internal fistula, improve the blood flow of internal fistula, and reduce the postoperative blood flow. The incidence of complications and so on, in order to provide a new idea for clinical practice. Methods through the computer, a comprehensive and systematic retrieval of the network, Wanfang, VP and other related databases, collected from January 1, 2006 to December 31, 2016 published in China on promoting blood circulation and stasis drugs to promote the maturation of internal arteriovenous fistula. "Traditional Chinese medicine" or "blood circulation and stasis removing drugs", "arteriovenous fistula" or "vascular access", selected randomized controlled trials, and then summarized the literature, collate and extract the relevant data, and used the Review Manager (Rev Man) version 5.2 software provided by Cochrane net to carry out Meta analysis and systematic evaluation of the extracted data. The results were finally included. 15 articles in accordance with the requirements, 15 literature studies were listed as 15 research projects, including 1050 cases of clinical randomized controlled trials, including 524 cases in the experimental group and 526 cases in the control group with.Meta analysis: 1. the comparison of the maturity of internal fistula: the combined effect of MD=-10.31,95%CI[-13.34, and the combination of -7.28]. studies Compared with the control group, the difference was statistically significant (Z=6.67, P0.00001), indicating that the experimental group was better than the control group in shortening the maturity of internal fistula; 2. the comparison of the blood flow of internal fistula: after the study of the combined effect of MD=57.69,95%CI[36.28,79.10]., the difference was statistically significant compared with the control group (Z=5.2 8, P0.00001), indicating that the experimental group was stronger than the control group in increasing the flow of internal fistula; 3. the comparison of the incidence of postoperative complications: after the study of the combination effect of each study, the difference was statistically significant (Z=4.10, P0.0001) compared with the control group (Z=4.10, P0.0001), indicating that the incidence of postoperative complications was reduced. The experimental group was superior to the control group; 4. the comparison of the maturity of internal fistula: the maturation of the fistula in the experimental group was better than the control group at 4 weeks, 6 weeks, 8 weeks and 12 weeks after the operation. The difference was statistically significant (P value was 0.0006,0.04,0.007,0.0008), and the comparison of the rate of first puncture success in the 5. two groups: the combined effect of OR=5.64,95%C After the I[1.92,16.55]. study, the experimental group and the control group were statistically significant (Z=3.15, P0.002), indicating that the experimental group was more successful in the first puncture success rate. Conclusion compared with western medicine, it has its own characteristics and advantages in promoting the maturation of arteriovenous fistula. Before operation of internal fistula operation, the use of traditional Chinese medicine for activating blood and removing stasis after operation can greatly reduce the maturity of arteriovenous fistula, increase the maturity of arteriovenous fistula, increase the blood flow of internal fistula, reduce the incidence of postoperative complications, and improve the success rate of the first puncture, which is worthy of further study and clinical popularization.
【學(xué)位授予單位】：湖北中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R692.5

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本文編號：2005140