舒洛地特在糖尿病慢性肾衰竭患者动静脉内瘘术围手术期的应用研究

目的探讨舒洛地特在糖尿病慢性肾衰竭患者动静脉内瘘术围手术期的应用价值。方法随机选取糖尿病慢性肾衰竭拟行自体动静脉内瘘术的患者60例，分为二组，术后分别给予舒洛地特和氯吡格雷治疗，于不同时间点检查血常规、C反应蛋白、凝血四项、血脂、内瘘血流量等指标，并观察并发症及药物不良反应。结果舒洛地特对纤维蛋白原、三酰甘油的影响较氯吡格雷有明显的差异（P〈0．01），而对血小板、凝血酶原时间、活化部分凝血活酶时间及凝血酶时间的影响二组无明显差异（P〉0．05）。二组对内瘘成熟过程中的血流量变化、静脉扩张程度的影响无明显差异（P〉0．05），但舒洛地特降低桡动脉阻力指数较氯吡格雷为优，二组差异明显（P〈0．01）。结论糖尿病慢性肾衰竭患者动静脉内瘘术后使用舒洛地特抗血栓治疗较氯吡格雷有更好的有效性和安全性。

Application of sulodexide in the perioperative period of internal arteriovenous fistulae in patients with both diabetes and chronic renal failure

Objective To explore the applied value of sulodexide in the perioperative period of internal arteriovenous fistulae in patients with both diabetes and chronic renal failure. Methods Sixty patients with both diabetes and chronic renal failure who would accept internal arteriovenous fistulae were randomly divided into two groups： sulodexide group, and clopidogrel group. Blood routine examination, C reaction protein, blood clotting function, and blood fat were surveyed, and blood flow rate ineluding related indexes were observed by ultrasound at both the first day and sixth week after opera- tion. Results Sulodexide could significantly decrease the levels of profibrin, triglyceride and C reaction protein as compared with clopidogrel（P〈0. 01）. There was no significant difference between sulodexide group and elopidogrel group in blood platelets, prothrombin time, partial thromboplastin time and thrombin time（P〉0. 05）. There was also no significant difference between sulodexide group and clopidogrel group in the blood flow rate and vein distensibility, but sulodexide could more significantly decrease artery resistant index（P〈0. 01）. Conclusions It is safer and more efficient to use sulodexide on patients with both diabetes and chronical renal failure after internal arteriovenous fistulae.