Abstract:

Objective To evaluate the clinical efficacy of preoperative quantitative compression arm exercises on the maturation of autogenous arteriovenous fistula（AVF） in peri-dialysis patients，and to provide a reference for clinical nursing practice. Methods A single-center，open-label，randomized controlled trial was conducted. Totally 60 patients scheduled for their first AVF creation surgery at the hemodialysis center of a tertiary A hospital in Nanjing from January 2022 to December 2023 were selected as study subjects. They were randomly assigned to either an experimental group（n=30） or a control group（n=30） using a random number table. The experimental group performed preoperative quantitative compression arm exercises for 2 weeks，using a pressure of 10 mmHg（1 mmHg=0.133 kPa），for 15~20 minutes each time，5 times daily. The control group performed non-quantitative arm exercises with the same frequency and duration starting 2 weeks before surgery. The cephalic vein diameter and blood flow volume were compared between the 2 groups on the first day before surgery and at 2，4，6，and 8 weeks after surgery. The maturation rate was assessed at the 8th week. Complications such as thrombosis and vascular stenosis were also observed. Results The experimental group and the control group ultimately included 29 and 26 cases，respectively. The AVF maturation rate in the experimental group was significantly higher than that in the control group（P<0.05），and the time to maturation at the 8th postoperative week was shorter in the experimental group（P<0.05）. The differences in cephalic vein diameter and fistula blood flow volume between groups，across different time points，and their interaction were all statistically significant（P<0.05）. Conclusion Preoperative quantitative compression arm exercises can improve vascular conditions，enlarge vessel diameter，facilitate AVF maturation，and reduce complications such as thrombosis and vascular stenosis，while ensuring fistula safety.

Key words: Arteriovenous Fistula, Maintenance Haemodialysis, Arm Exercises, Maturation, Nursing Care

摘要：

目的 评估术前量化加压束臂运动对围透析期患者自体动静脉内瘘（internal arteriovenous fistula，AVF）成熟的影响，为临床护理实践提供参考。 方法 采用单中心、开放、随机对照研究设计，选取2022年1月—2023年12月南京市某三级甲等医院血液净化中心首次拟行AVF成型术的60例患者作为研究对象，按计算机产生的随机序列号分为试验组30例和对照组30例。试验组术前2周给予量化加压束臂运动，压力为10 mmHg（1 mmHg=0.133 kPa），每次15~20 min，每天5次，持续2周。对照组术前2周开始给予非量化束臂运动，频次、持续时间同试验组。比较两组术前第1天，术后2、4、6、8周头静脉血管内径以及血流量，并且于第8周评估内瘘成熟率。同时观察血栓形成以及血管狭窄等并发症。 结果 试验组最终纳入29例，对照组最终纳入26例。试验组AVF成熟率高于对照组（P<0.05），且术后第8周成熟时间短于对照组（P<0.05）。内瘘头静脉血管内径以及内瘘血流量不同组间、时间点和交互作用均有统计学意义（P<0.05）。 结论 术前量化加压束臂运动能够保障血液透析患者AVF安全的同时改善血管条件，扩大血管内径，促进AVF成熟，减少血栓、血管狭窄等并发症。

关键词: 动静脉内瘘, 维持性血液透析, 束臂运动, 成熟度, 护理