外用活血散结方改善维持性血液透析患者自体动静脉内瘘功能临床观察  

Clinical study of externally used Huoxue Sanjie Formula for autologous arteriovenous fistula in maintenance hemodialysis patients

作　　者：史月欣 刘福生 曹钋[1] 钟剑[1] 魏宇 孙鲁英 孙卫卫[1] 姚志 刘正平 SHI Yuexin;LIU Fusheng;CAO Po;ZHONG Jian;WEI Yu;SUN Luying;SUN Weiwei;YAO Zhi;LIU Zhengping(Dongzhimen Hospital,Beijing University of Chinese Medicine,Beijing 100029;Dongfang Hospital,Beijing University of Chinese Medicine;Fangshan Hospital,Beijing University of Chinese Medicine)

机构地区：[1]北京中医药大学东直门医院,北京100700 [2]北京中医药大学东方医院 [3]北京中医药大学房山医院

出　　处：《现代中医临床》2022年第2期1-6,18,共7页Modern Chinese Clinical Medicine

基　　金：国家科技支撑计划项目(No.2011BAI10B01);中央高校基本科研业务费专项资金资助(No.2018-JYB-JS086);北京中医药大学教育科学研究课题(No.XJYB1950)。

摘　　要：目的观察外用活血散结方改善维持性血液透析患者自体动静脉内瘘功能的临床疗效。方法将98例维持性血液透析的患者建立1个队列,按是否接受外用活血散结方治疗作为暴露因素分为治疗组和对照组。剔除脱落病例后治疗组40例、对照组52例。对照组患者采用常规内瘘保护措施,治疗组在对照组治疗的基础上外用活血散结方。观察2组内瘘首次通畅丧失情况、内瘘并发症发生情况、因内瘘问题就诊或住院情况、内瘘首次通畅率及首次通畅时间,并对可能影响内瘘首次通畅的相关因素进行单因素和多因素分析。结果6个月随访时治疗组与对照组内瘘首次通畅丧失情况比较差异无统计学意义(P>0.05)。12个月和18个月随访时治疗组内瘘首次通畅丧失比率均低于对照组(P<0.05)。截至末次随访,治疗组与对照组内瘘并发症发生率比较差异均无统计学意(P>0.05)。6个月随访时治疗组与对照组因内瘘问题就诊或住院情况比较差异无统计学意义(P>0.05)。12个月和18个月随访时治疗组因内瘘问题就诊或住院率均低于对照组(P<0.05)。Log-rank检验显示,治疗组内瘘的首次通畅率高于对照组,首次通畅时间长于对照组,差异有统计学意义(P<0.05)。单因素分析结果显示血磷≥1.8 mmol/L、血浆白蛋白≥40 g/L、外用活血散结方、透析中发生低血压对内瘘首次通畅的影响有统计学意义(P<0.01)。多因素分析结果显示透析中发生低血压是内瘘首次通畅丧失的独立危险因素,外用活血散结方、血浆白蛋白≥40 g/L是内瘘首次通畅丧失的独立保护性因素。结论外用活血散结方对改善维持性血液透析患者自体动静脉内瘘功能具有较好的临床疗效。Objective To observe the clinical efficacy of externally used Huoxue Sanjie Formula in improving autologous arteriovenous fistula in patients with maintenance hemodialysis.Methods Ninety-eight patients with maintenance hemodialysis were assigned to the treatment group and the control group according to whether they used externally Huoxue Sanjie Formula.There were 40 left in the treatment group and 52 left in the control group,with the withdrawals excluded.The control group was treated with routine protection measures,and the treatment group was additionally treated with Huoxue Sanjie Formula.The primary patency loss of autologous arteriovenous fistula,the occurrence of autologous arteriovenous fistula complications,the situation of seeking medical treatment or hospitalization due to fistula problems,the primary patency rate and the primary patency time of autologous arteriovenous fistula in the two groups were observed,and the related factors that may affect the primary patencyth of internal fistula were analyzed by single factor and multi factor analysis.Results There was no significant difference in the primary patency loss of internal fistula between the treatment group and the control group at 6 th month follow-up(P>0.05).At the 12 th month and 18 th month follow-ups,the primary patency loss rate of autologous arteriovenous fistula was lower in the treatment group than in the control group(P<0.05).As of the last follow-up,there was no significant difference in the incidence of autologous arteriovenous fistula complications between the treatment group and the control group(P>0.05).At the 6 th month follow-up,there was no significant difference between the treatment group and the control group(P>0.05).At the 12 th month and 18 th month,the rate of seeking medical treatment or hospitalization due to fistula problems was lower in the treatment group than in the control group(P<0.05).Log rank test showed that the primary patency rate of internal fistula was higher in the treatment group than in the control group,a

关 键 词：血液透析 自体动静脉内瘘 队列研究 活血散结方 首次通畅 

分 类 号：R256.6[医药卫生—中医内科学]