Experimental Study On Prevention And Treatment Of Complications Of Arteriovenous Fistula By Salvia Miltiorrhiza Injection Combined With Low Intensity Laser Local Vascular Irradiation

Objectives The model of arteriovenous fistula(AVF)in the neck of New Zealand rabbits was established to study the prevention and treatment effects of Salvia miltiorrhiza injection combined with low-intensity laser local vascular irradiation on AVF complications,and to explore its mechanism of action,so as to provide a strong theoretical basis for guiding clinical practice.Methods The arteriovenous fistula model of 28 healthy New Zealand rabbits was established and randomly divided into 4 groups with 7 rabbits in each group.1.Control group: After internal fistula operation,there was no treatment.2.Anastomosis irradiation group:After internal fistula operation,the local anastomotic vessels were irradiated for 15 min immediately before suturing the skin with a power density of 50mw/cm2.After irradiation,the skin incision was sutured layer by layer,and then the incision was irradiated with the same power and time as above.One course of treatment was 7 times,and two courses of treatment were continuous,i.e.14 days of continuous irradiation.3.Extravascular irradiation group: After internal fistula surgery,skin incision was sutured layer by layer,and extravascular irradiation was performed on the incision every day with a power density of 50mw/cm2 once a day for 15 min each time for 14 consecutive days.4.group of traditional Chinese medicine+extravascular irradiation: after operation,salvia miltiorrhiza injection(1.6ml/kg/d)was given intravenously and extravascular irradiation was given.the irradiation method and time were the same as above.On the4 th day after the operation,the animals were killed in week.The vessels in the venous segment of the fistula were taken and stained with HE,Masson and PAS to measure the intimal thickness.The positive rates of local proliferating cell nuclear antigen(PCNA)and Alpha-actin in smooth muscle cells were detected by immunohistochemistry.The expression level of soluble P-selectin was detected by enzyme-linked immunosorbent assay(ELISA).Result Compared with the control group,the intimal thickness of the anastomosis irradiation group,the extravascular irradiation group and the traditional Chinese medicine+extravascular irradiation group decreased significantly(P<0.01).The proliferation rate of Vascular smooth muscle cell(VSMC)decreased(P<0.05).The expression of Alpha-actin in intima of blood vessel was decreased,and the difference between groups was statistically significant(P< 0.05).The content of soluble P-selectin in plasma was significantly decreased,and the differences between groups were statistically significant(P<0.01).The intima thickness in the extravascular irradiation group was significantly thicker than that in the anastomotic irradiation group and the traditional Chinese medicine+extravascular irradiation group,and the difference between the groups was statistically significant(P<0.05).However,there was no significant difference between anastomotic irradiation group and traditional Chinese medicine+extravascular irradiation group(P>0.05).Compared with the extravascular irradiation group,the contents of soluble P-selectin in plasma of anastomotic irradiation group and traditional Chinese medicine+extravascular irradiation group were significantly decreased(P<0.05).The content of plasma soluble P-selectin in anastomotic irradiation group was significantly higher than that in traditional Chinese medicine+extravascular irradiation group,and the difference between groups was statistically significant(P<0.01).Compared with the extravascular irradiation group,the proliferation rate of smooth muscle cells and the number of Alpha-actin positive cells in the traditional Chinese medicine+extravascular irradiation group were significantly reduced,and the differences between the groups were statistically significant(P<0.05).The proliferation rate and the number of Alpha-actin positive cells decreased in the anastomotic irradiation group,but there was no significant difference between the groups(P>0.05).The cell proliferation rate and the number of Alpha-actin positive cells in the anastomotic irradiation group were higher than those in the traditional Chinese medicine+extravascular irradiation group,but there was no significant difference between the groups(P>0.05).Conclusion Salvia miltiorrhiza injection combined with low-intensity laser local vascular irradiation can effectively inhibit the proliferation and migration of vascular smooth muscle cells in the anastomotic vein segment,thus reducing intimal hyperplasia,inhibiting the expression of soluble P-selectin in plasma,inhibiting platelet activity,thus affecting thrombosis,and having the effect of preventing and treating AVF complications.