CAJ | 학술논문

【目的】探讨注射用前列地尔干乳剂对糖尿病肾病造瘘血管血流量的影响。【方法】选择本院收治的糖尿病肾病终末期肾衰行血液透析的患者46例，随机分为A组和B组，均行桡动脉‐头静脉端端吻合术。A组患者术后予常规换药处理；B组术后给予注射用前列地尔干乳剂10μg静脉注射，共10 d。采用彩色血管多普勒超声每隔3 d检查两组患者吻合口血流量，观察比较其变化。【结果】①治疗10d后彩色多普勒超声检查A组血流量为31957 mL／min；B组血流量为42572 mL／min ，B组内瘘血流量血明显高于A组，且两组相比较差异有显著性（ P ＜0．05）。②A组有12例术后出现内瘘处血流减弱，血管震颤减弱、血管杂音降低，发生率为52．17％（12／23），经保守治疗同时加强前臂功能锻炼1周后好转；B组有2例术后d3出现血管震颤及血管杂音减弱，发生率为8．69％（2／23），明显低于A组，且两组相比较差异有显著性（ P＜0．05）。2例患者加强功能锻炼2 d后好转；有1例术后次日出现术肢肿胀，瞩其抬高患肢，1周后肿胀逐渐消失。两组均未发现切口感染及术区渗漏液体情况。【结论】注射用前列地尔干乳剂有预防糖尿病肾病动静脉内瘘术后狭窄或闭塞，增加血流量、提高手术成功率的作用。
【목적】탐토주사용전렬지이간유제대당뇨병신병조루혈관혈류량적영향。【방법】선택본원수치적당뇨병신병종말기신쇠행혈액투석적환자46례，수궤분위A조화B조，균행뇨동맥‐두정맥단단문합술。A조환자술후여상규환약처리；B조술후급여주사용전렬지이간유제10μg정맥주사，공10 d。채용채색혈관다보륵초성매격3 d검사량조환자문합구혈류량，관찰비교기변화。【결과】①치료10d후채색다보륵초성검사A조혈류량위31957 mL／min；B조혈류량위42572 mL／min ，B조내루혈류량혈명현고우A조，차량조상비교차이유현저성（ P ＜0．05）。②A조유12례술후출현내루처혈류감약，혈관진전감약、혈관잡음강저，발생솔위52．17％（12／23），경보수치료동시가강전비공능단련1주후호전；B조유2례술후d3출현혈관진전급혈관잡음감약，발생솔위8．69％（2／23），명현저우A조，차량조상비교차이유현저성（ P＜0．05）。2례환자가강공능단련2 d후호전；유1례술후차일출현술지종창，촉기태고환지，1주후종창축점소실。량조균미발현절구감염급술구삼루액체정황。【결론】주사용전렬지이간유제유예방당뇨병신병동정맥내루술후협착혹폐새，증가혈류량、제고수술성공솔적작용。
[Objective] To explore the application of alprostadil dry emulsion in patients with diabetic nephro‐pathic arteriovenous fistulation .[Methods] A total of 46 diabetics with chronic renal failure were divided into groups A and B .Both groups underwent radial artery‐cephalic vein standard fistulation .Group A received conven‐tional treatment after operation while group B group had an intravenous injection of alprostadil 10 μg for 10 days . And the anastomotic flow was observed once by color vascular Doppler ultrasound every 4 days .[Results] Color Doppler ultrasonography revealed that blood flow in fistula was 319 57 ml/min in group A versus 425 72 ml/min in group B after 10‐day treatment .Blood flow increased compared to those before treatment with statistical signifi‐cance ( P<0 .05) .And 12 patients in group A showed that vascular tremor in fistula weakened in the first day af‐ter operation and vascular murmur decreased .Recovery occurred within 1 week through strengthening hand func‐tion training .Among 3 patients with fistula occlusion ,2 patients in group B showed that vascular tremor in fistula weakened and vascular murmur decreased in the third day after operation .Recovery occurred within 2 days after strengthening function training .One case in group B suffered limb swollen in the day after operation .And it re‐solved automatically within 1 week .There were no wound infection and bleeding in both groups .[Conclusion]Al‐prostadil dry emulsion may prevent stenosis or occlusion ,increase blood flow and improve the success rate of sur‐gery after arteriovenous fistulation .