中国血液净化

中国血液净化 ›› 2018, Vol. 17 ›› Issue (04): 277-280.doi: 10.3969/j.issn.1671-4091.2018.04.0017

• 血管通路 • 上一篇    下一篇

促进动静脉内瘘成熟的一种锻炼设备的设计与应用

傅丽丽1,王云燕1,向杨1,封蕾1   

  1. 1. 第三军医大学大坪医院野战外科研究所肾内科血液净化中心
  • 收稿日期:2017-06-20 修回日期:2018-01-11 出版日期:2018-04-12 发布日期:2018-04-12

Design and application of a training device to promote maturation of internal arteriovenous fistula

  • Received:2017-06-20 Revised:2018-01-11 Online:2018-04-12 Published:2018-04-12

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摘要： 【摘要】目的观察自行设计的动静脉内瘘锻炼握力检测装置的应用对内瘘成熟的影响。方法选择2015 年1～12 月在第三军医大学大坪医院野战外科研究所行自体动静脉内瘘成形术，且留我中心行维持性血透患者58 例为对照组；选择2016 年1～12 月在我中心行自体动静脉内瘘成形术，且留我中心行维持性血透患者49 例为观察组。对照组和观察组均在术后2 周拆线后，按照相同的方法进行握力锻炼：挤压握力器15 秒，缓慢放松，重复上述动作，10imin/次，5～10 次/天。对照组：采用常规握力器进行锻炼；观察组：采用带有握力检测装置的握力器进行锻炼，在锻炼前患者预先通过输入装置输入标准参数(包括标准握力值、标准练习次数和练习时间)，锻炼结束后通过查看显示屏或语音提示和指示灯提示，对未达到标准握力的锻炼次数进行重新设定和补充锻炼。观察2 组患者术后第4、8、12 周头静脉血管内径、血流量检测，内瘘成熟率和成熟时间，实施握力锻炼依从性。结果术后第4 周、8 周、12 周，观察组头静脉血管内径分别为(4.73±0.51)mm，(4.89±0.65)mm，(5.15±0.95)mm，高于对照组的(4.30±0.65)mm，(4.41±0.71)mm，(4.65±0.89)mm(t=-2.970，P=0.004；t=-2.298，P=0.025，t=-2.928，P= 0.041)；观察组头静脉血流量分别为(501.12 ± 125.32)ml/min，(568.13 ± 183.39)ml/min，(675.33 ± 213.04)ml/min，高于对照组的(443.64 ± 112.21)ml/min，(496.88 ± 164.74)ml/min，(538.84 ± 190.08)ml/min (t=3.003，P=0.005t=2.932，P=0.006t=2.765，P=0.001)。观察组内瘘成熟率为97.96%，与对照组87.94%相比，差异有统计学意义(χ2=3.861, P=0.049)，且观察组内瘘成熟时间比对照组提前1.75 周。观察组握力锻炼依从性明显高于对照组，差异有统计学意义(χ2= 12.365, P=0.002)。结论握力检测装置的使用，能让患者更加积极、主动参与握力锻炼，提高患者依从性，保证锻炼的规范性，提高锻炼的有效性，促进内瘘提早成熟。

关键词: 动静脉内瘘, 功能锻炼, 握力监测装置, 成熟

Abstract: 【Abstract】Objective To observe the effect of a self- designed device for training grip strength on the maturation of internal arteriovenous fistulas. Methods A total of 49 patients on maintenance hemodialysis treated with autologous arteriovenous fistula surgery in the period from Jan. 2016 to Dec. 2016 were recruited as observation group, and a total of 58 patients on maintenance hemodialysis treated with the surgery in the period from Jan. 2015 to Dec. 2015 were used as control group. After the surgery for 2 weeks, they were asked to train grip strength: squeezing the palm squeezer for 15 seconds then relaxing slowly, repeating this training for 10 minutes and 5-10 times/day. A conventional grip device was used for the training in control group. For observation group, a grip device with grip strength monitor was used. Parameters of standard grip strength, exercise times and duration were input in the device before training. After the training, the actual training parameters including grip strength, exercise times and duration were displayed on the device or alerted by voice or lights. When the standard parameters were not achieved, required parameters were reset in the device, and the patient was asked to continue the exercise to meet the standard parameters. Diameter of the cephalic vein, blood flow, maturation degree, maturation period of the fistula, and compliance of grip training were evaluated after the surgery for 4, 8 and 12 weeks. Results After the surgery for 4, 8 and 12 weeks, diameters of the cephalic vein were 4.73±0.51mm, 4.89±0.65 and 5.15±0.95mm respectively in observation group, bigger than the diameters of 4.30±0.65mm, 4.41±0.71mm and 4.65±0.89mm respectively in control group (t=-2.970, -2.298 and - 2.928 respectively; P=0.004, 0.025 and 0.041 respectively); blood flows in cephalic vein were (501.12±125.32)ml/min, (568.13±183.39)ml/min, (675.33±213.04)ml/min respectively in observation group, higher than the blood flows of (443.64±112.21)ml/min, (496.88±164.74)ml/min, 538.84±190.08 ml/min re-spectively in control group (t=3.003, 2.932 and 2.765 respectively; P=0.005, 0.006 and 0.001 respectively). The maturation rate of fistula was 97.96% in observation group and was 87.94% in control group (χ2=3.861, P=0.049). The maturation duration was 1.75 weeks earlier in observation group than in control group. The compliance of grip strength training was higher in observation group than in control group (χ2=12.365, P=0.002). Conclusion The use of self-designed device is helpful for patients to actively train grip strength, to standardize the training, to improve compliance and training efficiency, and thus promotes fistula maturation after the surgery.

Key words: Autogenous arteriovenous fistula, Functional exercise,  Grip force monitoring device, Maturation