活血散结膏对血液透析患者自体动静脉内瘘瘢痕的影响  

Effect of Huoxue Sanjie Ointment on Autologous Arteriovenous Fistula Scar in Hemodialysis Patients

作　　者：魏宇 宋雅丽 曹钋[1] 钟剑[1] 刘变玲[2] 袁丽莎 豆芳梅 赵淑娅 王薇薇 张子君 WEI Yu;SONG Yali;CAO Po;ZHONG Jian;LIU Bianling;YUAN Lisha;DOU Fangmei;ZHAO Shuya;WANG Weiwei;ZHANG Zijun(Dongzhimen Hospital Affliated to Beijing University of Chinese Medicine,Beijing China 100700;Zhengzhou People′s Hospital,Zhengzhou Henan China 450000;Beijing University of Chinese Medicine,Beijing China 100029)

机构地区：[1]北京中医药大学东直门医院,北京100700 [2]郑州人民医院,河南郑州450000 [3]北京中医药大学,北京100029

出　　处：《中医学报》2020年第12期2677-2681,共5页Acta Chinese Medicine

基　　金：北京中医药大学基本科研业务费项目(青年教师项目)(2018-JYB-JS086)。

摘　　要：目的:对比活血散结膏与喜辽妥软膏(多磺酸黏多糖乳膏)外用,改善长期血液透析患者前臂自体动静脉内瘘(autogenous arteriovenous fistula,AVF)瘢痕的疗效差异。方法:将长期做血液透析的患者60例,按照随机数字表法分为中药组30例和西药组30例。中药组采用自制活血散结膏外敷,对照组采用喜辽妥软膏外敷。治疗6个月,观察记录温哥华瘢痕量表(vancouver scar scale,VSS)评分,硬结面积的改善情况,以及皮肤红肿、皮下瘀血、内瘘狭窄、内瘘栓塞及不良反应的发生情况。结果:治疗后,中药组瘢痕色泽(Z=-2.714,P=0.007)、瘢痕柔软度(Z=-2.070,P=0.038)、瘢痕总分(Z=-2.809,P=0.005)较治疗前明显降低,差异有统计学意义(P<0.05);西药组瘢痕评分较治疗前有所降低,但差异无统计学意义(P>0.05);两组治疗前后瘢痕评分差值比较,差异无统计学意义(P>0.05)。两组治疗前后硬结面积比较,差异有统计学意义(P=0.002<0.05),而治疗后两组比较,差异无统计学意义(P=0.669>0.05)。中药组皮下瘀血发生次数少于西药组,差异有统计学意义(P=0.027<0.05);两组皮肤红肿、内瘘狭窄、内瘘栓塞的发生率比较,差异无统计学意义(P>0.05);两组均未发生不良反应。结论:采用自制活血散结膏可显著改善血液透析患者自体动静脉内瘘的瘢痕色泽及柔软度,可更好地预防内瘘处皮下瘀血的发生。自制活血散结膏与喜辽妥软膏均可减小治疗前后的硬结面积。Objective:To compare the effect of Huoxue Sanjie Ointment and Xiliaotuo Ointment(polysulfonic mucopolysaccharide cream)for external use in improving forearm autogenous arteriovenous fistula(AVF)scars in long-term hemodialysis patients.Methods:Sixty patients undergoing long-term hemodialysis were randomly divided into a Chinese medicine group and 30 Western medicine groups according to a random number table.The traditional Chinese medicine group was treated with self-made Huoxue Sanjie Ointment for external application,and the control group was treated with Xiliaotuo Ointment for external application for 6 months.The Vancouver Scar Scale(VSS)score,the improvement of induration area,and skin redness and swelling were observed and recorded.,Subcutaneous blood stasis,internal fistula stenosis,internal fistula embolism and adverse reactions.Results:After treatment,the scar color(Z=-2.714,P=0.007),scar softness(Z=-2.070,P=0.038)and total scar score(Z=-2.809,P=0.005)of the Chinese medicine group were compared with those before treatment the comparison was significantly lower(P<0.05);the scar score in the western medicine group was lower than before treatment,and the difference was not statistically significant(P>0.05);the difference in scar score between the two groups before and after treatment was compared and the difference was not statistically significant(P>0.05).The results of using repeated measures analysis of variance to compare the size of the induration area showed that the difference in time effect was statistically significant(P=0.002<0.05),while the difference between the group effects was not statistically significant(P=0.669>0.05).The incidence of subcutaneous blood stasis in the Chinese medicine group was less than that in the western medicine group,and the difference was statistically significant(P=0.027<0.05);there was no statistical difference in the incidence of skin redness,swelling,internal fistula stenosis,and internal fistula embolism(P>0.05);no adverse reactions occurred in the two groups.Concl

关 键 词：动静脉内瘘 血液透析 活血散结膏 瘢痕 硬结 喜辽妥软膏 

分 类 号：R259.436[医药卫生—中西医结合]