中国血液净化

中国血液净化 ›› 2013, Vol. 12 ›› Issue (06): 301-304.doi: 10.3969/j.issn.1671-4091.2013.06.00

• 临床研究 • 上一篇    下一篇

氢氯吡格雷与双嘧达莫预防自体大隐静脉移植内瘘失功的有效性和安全性比较

刘金彦,周清华,周生国,吴玉梅,刘金荣,朱彬   

  1. 山东省济宁市第一人民医院肾内科
  • 收稿日期:2013-01-18 修回日期:2013-03-31 出版日期:2013-06-12 发布日期:2013-07-01
  • 通讯作者: 朱彬 zhubin@medmail.com.cn E-mail:jinyan_liu@sina.com

Comparison of clopidogre and dipyridamole for preventing dysfunction of the autologous fistula by great saphenous venous transposition

  • Received:2013-01-18 Revised:2013-03-31 Online:2013-06-12 Published:2013-07-01

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摘要： 摘要 目的 比较氢氯吡格雷和双嘧达莫对预防自体大隐静脉移植内瘘失功的临床疗效及安全性。方法 前瞻性纳入2009年1月至2012年05月期间行自体大隐静脉移植内瘘的患者，术后随机分为氢氯吡格雷治疗组（A组），双嘧达莫治疗组（B组），于治疗后3个月及6个月观察移植静脉内瘘的通畅率、狭窄率、动脉吻合口内径、静脉吻合口内径、动脉段内径(距动脉吻合口3cm)及静脉段内径(距静脉吻合口3cm)等指标，以及药物并发症和不良反应。使用SPSS17.0 软件进行统计分析。结果 共纳入病例30例，其中A组16例，B组14例。A组治疗3个月、6个月的通畅率均较B组的高，狭窄率均较B组的低。其中A组治疗6个月的通畅率（81.25%）较B组（35.71%）的差异有显著性（P=0.024），A组治疗3个月动脉吻合口、静脉吻合口内径较B组略大，但差异无显著性（P＞0.05），相应时段移植静脉动脉段内径(距动脉吻合口3cm)及静脉段内径(距静脉吻合口3cm)差异无显著性；A组治疗6个月动脉吻合口、静脉吻合口内径较B组大，差异有显著性（P值分别为0.041、0.042），相应时段移植静脉动脉段内径(距动脉吻合口3cm)及静脉段内径(距静脉吻合口3cm)略大，但差异无显著性。两组均未出现严重不良反应。结论 氢氯吡格雷预防自体大隐静脉移植内瘘狭窄及血栓形成的效果优于双嘧达莫，无明显不良反应，具有广阔的应用前景。

关键词: 大隐静脉, 内瘘, 失功, 氢氯吡格雷, 双嘧达莫

Abstract: 【Abstract】 Objective To compare the efficacy and safety of clopidogre and dipyridamole for the prevention of autologous great saphenous venous transposition fistula dysfunction. Methods We prospectively recruited patients who received the operation of autologous great saphenous venous transposition fistula. After the surgery, patients were randomly assigned into either clopidogre group (group A) or dipyridamole group (group B). At the 3rd and 6th months after the enrollment, fistula patency, stenosis rate, arterial anastomotic diameter, venous anastomotic diameter, diameters of the arterial/venous graft segments (3cm from arterial/venous anastomotic sites), complications, and adverse events were recorded. Data were analyzed by using SPSS 17.0 software. Results We observed 30 patients, of which 16 were in group A, and 14 were in group B. At the time points of 3rd and 6th months, group A had a higher fistula patency rate and a lower stenosis rate than group B. At the 6th month, fistula patency was statistically significant between the two groups (P=0.024). Arterial and venous anastomotic diameters were slight wider in group A than in group B but without statistical significance (P＞0.05) at the 3rd month, and were significant larger in group A than in group B (P=0.041 and 0.042, respectively) at the 6th month. Diameters of the arterial/venous graft segments were similar between the two groups at 3rd and 6th months. No severe adverse effects were reported in either of the two groups. Conclusions Clopidogre is superior to dipyridamole in the prevention of thrombosis and stenosis in autologous great saphenous venous transposition fistula without notable adverse effects. As an anti-platelet therapy for fistula preservation, clopidogre shows better effects for clinical use.

Key words: Great saphenous vein, Fistula, Dysfunction, Clopidogre, Dipyridamole