Abstract:

Objective To explore the starting time of perioperative functional exercise in patients with arteriovenous fistula. Methods It was a randomized controlled trial. Totally 43 patients with arteriovenous fistula were randomly divided into A,B and C groups,starting to guide functional exercise 3 days after surgery（Group A）,12 hours after surgery（Group B）,and 2 weeks before surgery（Group C）. Internal diameter of cephalic vein was compared among three groups at 2 weeks,1 day before surgery,as well as 2 weeks,4 weeks and 8 weeks after surgery;anastomotic blood flow was compared among three groups at 2 weeks,4 weeks and 8 weeks after surgery;maturation time and complications of arteriovenous fistula of three groups were compared. Results Internal diameter of cephalic vein gradually widened with time after surgery among three groups,and the difference was statistically significant （P<0.05）;the widening speed of internal diameter of cephalic vein in Group A and B were both lower than Group C（P<0.05） at 2 weeks,4 weeks and 8 weeks after surgery;internal diameter of cephalic vein 1 day before surgery in Group C was greater than 2 weeks before surgery（P<0.05）. The anastomotic blood flow in Group A and B were increased rapidly（P<0.05） after surgery;the anastomotic blood flow in Groups A and B was significantly lower than Group C,and the difference were statistically significant（P<0.05） at 2 weeks,4 weeks and 8 weeks after surgery. Maturity time of Group C was shorter than Group A and B（P<0.05）. There was no statistically significant difference in complications among 3 groups（P>0.05）. Conclusion The functional exercise of lateral limbs in patients with arteriovenous fistula before surgery and early after surgery can increase internal diameter and blood flow of blood vessels,improve blood vessel conditions and shorten maturation time of arteriovenous fistula under the premise of ensuring safety of arteriovenous fistula.

Key words: Arteriovenous Fistula, Renal Dialysis, Perioperative Period, Functional Exercise, Nursing Care

摘要：

目的 探讨动静脉内瘘围手术期患者功能锻炼开始时间。 方法 采用随机对照研究方法,将43例动静脉内瘘围手术期患者随机分为A、B、C 3组,分别于术后3 d（A组）、术后12 h（B组）及术前2周（C组）开始指导功能锻炼,比较3组术前2周、术前1 d、术后2周、4周及8周头静脉内径;比较3组术后2周、4周及8周吻合口血流量;比较3组动静脉内瘘成熟时间及并发症发生情况。 结果 3组头静脉内径术后均随着时间的推移逐步增宽,差异有统计学意义（P<0.05）;A、B 2组头静脉内径术后2周、4周及8周增宽速度低于C组（P<0.05）;C组术前1 d头静脉内径大于术前2周（P<0.05）。A、B 2组术后随着时间的变化吻合口血流量得到快速提升（P<0.05）;A、B两组术后2周、4周及8周吻合口血流量明显低于C组,差异有统计学意义（P<0.05）。C组成熟时间较A、B组短（P<0.05）。3组并发症比较,差异无统计学意义（P>0.05）。 结论 动静脉内瘘手术患者手术前及手术后早期有针对性地实施术侧肢体的功能锻炼,可在保障动静脉内瘘安全的前提下,增大血管内径及血流量,改善血管条件,缩短动静脉内瘘成熟时间。

关键词: 动静脉瘘, 肾透析, 围手术期, 功能锻炼, 护理