| Objective:According to whether the patients after AVF were treated with short-term low-molecular-weight heparin,the incidence of AVF maturation disorder and AVF maturation time between the experimental group and the control group were compared.It provides a scientific theoretical basis for the prevention of AVF maturation in the future.Methods:From June 1,2021 to December 31,2022,60 patients with chronic renal insufficiency of stage 4-5,aged over 50 years,head vein diameter of 2.0mm ± 0.5mm,radial artery diameter of 1.5mm ± 0.5mm,who were hospitalized in the vascular surgery of the People’s Hospital of Inner Mongolia Autonomous Region,and who did not enter the dialysis state before the maturity of AVF were selected.Cases were divided into an experimental group(30 cases)and a control group(30 cases).Both groups of patients were given pre-operative training,preoperative preparation,preoperative evaluation and examination of fistula vessels,recording the diameter of their cephalic vein and radial artery,changing the dressing after surgery,and informing the patients of the protection of AVF after surgery.The operation was performed by cephalic vein radial artery end to side anastomosis.The size of AVF anastomosis was 1cm.The experimental group was given 100 units of low molecular weight heparin per kg on the day after operation for 7 consecutive days.The control group was not given any drug injection or other additional treatment.CRP test was performed on the 7th day,the 1st month and the 3rd month after operation,and the CRP value of patients was recorded.At the first week,the first month and the third month after operation,the outpatient reexamination was carried out,and the AVF blood flow,vessel diameter and thickness from skin were measured by color ultrasound.(The first week after the operation,during the hospitalization,the first month and the third month,the patient was asked to take outpatient reexamination).If the AVF meets the dialysis requirements(i.e.the fistula reaches the blood flow>600ml/min,the vessel diameter>0.6cm,and the subcutaneous depth<0.6cm)and the dialysis is successfully completed,record the time from the establishment of AVF to the maturity of AVF.All the clinical data collected shall be strictly checked,entered into the corresponding database,and analyzed with statistical software.Result:1.A total of 60 patients(case group: 30,control group: 30)were enrolled in this trial.After operation,1 patient in the experimental group had skin ecchymosis,hematoma in the operation area,bloody stool and other adverse reactions,with no statistical difference.2.The incidence of thrombosis in the control group was higher than in the experimental group,but the cardinal value χ2=1.346,p=0.246 was not statistically different when comparing the two groups.Blood flow comparison at 7 days postoperatively was(308.83±33.28)ml/min in the control group and(395.07±48.90)ml/min in the experimental group.Comparison of head vein inner diameter at 7 days postoperatively was(2.86±0.53)mm in the control group and(3.49±0.70)mm in the experimental group.Comparison of talar thickness at 7 days postoperatively was(2.86±0.53)mm and(3.49±0.70)mm in the experimental group.CRP values at 7days postoperatively were 17.33±2.39 in the control group and 8.24±1.24 in the experimental group,which were better than those in the control group and were statistically different(P<0.05).3.In both the experimental and control groups,one patient had a thrombosis at1 month postoperatively,accounting for 4.0% and 3.8% respectively(χ2=0.000,p=1.000).The AVF maturation rate was 53.8% in the experimental group and 32.0% in the control group(χ2=2.480,p=0.115)and there was no statistical difference between the two groups.The blood flow velocity at 1 month after surgery was(488.12±60.48)ml/min in the control group and(590.27±48.75)ml/min in the experimental group and the internal diameter of the portal vein at 1 month after surgery was(4.42±0.92)mm in the control group and(5.13±0.89)mm in the experimental group.The difference was statistically significant(P<0.05).Postoperative talar thickness at 1 month was(2.92±0.97)mm in the control group and(2.63±0.96)mm in the experimental group.At 1 month,the postoperative CRP was 6.99±2.50 in the control group and 5.72±2.55 in the experimental group.However,the experimental group was better than the control group,but the difference was not statistically significant(P>0.05).4.At 3 months after surgery,there were no thrombosis patients in either group and the AVF maturation rate was 92.0% in the experimental group.The rate in the control group was 66.7%,the experimental group was better than the control group,but there was no statistical difference between the two groups(χ2=3.404,p=0.065).The blood flow 3 months after surgery was(643.79±73.01)ml/min in the control group and(735.48±72.76)ml/min in the experimental group,and the internal diameter of the portal vein 3 months after surgery was(5.31±0.52)mm in the control group and(6.11±0.87)mm in the experimental group.The difference was statistically significant(P<0.05).Postoperative talar thickness at 3 months was(2.06±0.75)mm in the control group and(2.12±0.85)mm in the experimental group.At 3 months,the postoperative CRP was 5.57±2.44 in the control group and 4.80±2.84 in the experimental group.The experimental group was still better than the control group,but the difference was not statistically significant(P>0.05).Conclusion:In this experiment,we found that the anti-inflammatory effect of low molecular weight heparin is obvious after the establishment of AVF.It is also believed that the anti-inflammation treatment of low molecular weight heparin in the early stage after AVF has a positive impact on the maturation of AVF in the later stage.Although there was no significant difference in the maturity rate between 1 month and 3 months after operation,the maturity rate and various detection indicators in the experimental group were significantly better than those in the control group.Therefore,the anti-inflammatory properties of LMWH have a certain effect on promoting the maturation of AVF.It can be used as one of the drugs to promote the maturation of AVF.The reason why the difference is not statistically significant is largely related to the small sample size of the experiment.Larger samples of experiments are needed to provide evidence-based medical evidence. |
PDF Full Text Request