罂粟碱联合低分子肝素钙在动静脉内瘘围手术期中的疗效观察

目的：探讨罂粟碱联合低分子肝素钙在动静脉内瘘围手术期中的疗效观察，以提高动静脉内瘘的初期开放率及远期成熟率。方法选取2008年7月-2013年9月医院确诊为慢性肾衰竭尿毒症期（CKD5期）的患者296例。随机分成治疗组和对照组各148例。治疗组予盐酸罂粟碱局部注射，术后予盐酸罂粟碱肌内注射，并于术后联合低分子肝素钙皮下注射；对照组仅术中予温0.9%氯化钠溶液局部注射。2组术后均予双密达莫口服并予丹参注射液静点。结果296例手术成功273例，总内瘘初期开放率92.2%。其中治疗组142例，初期开放率95.8%；对照组131例，初期开放率88.5%。2组比较差异有统计学意义（P ﹤0.05）。初次手术成功的273例患者随访3个月，258例达到内瘘成熟，总成熟率94.5%。其中治疗组140例，成熟率98.6%；对照组118例，成熟率90.1%，2组比较差异有统计学意义（P ﹤0.05）。2组均未出现明显不良反应。结论罂粟碱联合低分子肝素钙在动静脉内瘘成形术围手术期中的应用能有效地缓解血管痉挛，预防血栓形成，提高手术成功率，提高内瘘初期放开率及远期成熟率。

The applied research of papaverine and low molecular heparin in peroperative period of internal arteriovenous fistula

Objective To explore the effect of pharmacal interventions in peroperative period of internal arteriove-nous fistula angioplasty,in order to improve the initial opening rate and the forward maturation rate. Methods 296 cases of patients diagnosed with chronic renal failure（uraemia stage V of chronic kidney dieases,CKD5 ）in our hospital from July 2008 to September 2013 were selected and randomly divided into treatment group and control group,with 148 patients in each groups. Patients in treatment group were treated by local injection with papaverine hydrochloride during the operation,and then by intramuscular injection with papaverine hydrochloride. After that,low molecular weight heparin was given by subcutaneous injection was accompanied post-operation. while the patients in control group were treated by local injection with warm saline during the operation. All of the patients in both groups were treated with oral dipyridamole and danshen injection. Results 273 cases of patients received successful operation in all the 296 patients,with the overall initial opening rate of 92. 2% ,inclu-ding 142 cases in treatment group with initial opening rate of 95. 8% and 131 cases in control group with initial opening rate of 88. 5% ,and the differences were statistically significant（P ﹤ 0. 05）. During the 3-month-follow-up,among 273 patients who received successful operations,mature internal arteriovenous fistula were seen in 258 patients,with the overall maturing rate of 94. 5% ,including 140 patients in treatment group with maturing rate of 98. 6% ,and 118 patients in control group with matu-ring rate of 90. 1% ,and the differences was also statistically significant（P ﹤ 0. 05）. There were no significant side effects in both groups. Conclusion The application of papaverine and low molecular heprin in peroperative period of internal arteriove-nous fistula could effectively remit vasospasm,prevent thrombosis,improve the achievement ratio of operation,so as to improve the initial opening rate and the forward