不同握力方式对前臂预行动静脉内瘘血管条件的影响

摘要

[目的]通过研究不同握力方式对前臂预行动静脉内瘘血管条件的影响.[方法]选择我院肾内科终末期肾病预行动静脉内瘘成形术但血管条件较差的病人88例,随机将病人分为4组:A组为使用手握握力器强档组(用力15.1 kg～20.0 kg),B组为中档组(用力10.1 kg～15.0 kg),C组为弱档组(用力5.0 kg～10.0 kg),D组为徒手握拳组;分别在锻炼前和锻炼后第2周、第4周进行血管彩色多普勒超声检查,观察桡动脉血流速度和头静脉血管直径变化.[结果]4组病人在锻炼前及锻炼2周后桡动脉血流速度比较差异无统计学意义(P＞0.05),在锻炼4周后桡动脉血流速度差异有统计学意义(P＜0.05);4组病人在锻炼前头静脉血管直径比较差异无统计学意义(P＞0.05),在锻炼2周后和4周后头静脉血管直径差异均有统计学意义(P＜0.05).[结论]对于预行动静脉内瘘术但血管条件较差未能达到手术要求的病人,早期进行握力器功能锻炼,可一定程度改善头静脉血管直径和桡动脉血流速度.%Objective:To study the effect of different grip modes on the vascular condition of pre-operative arteriovenous fistula in forearm.Methods:A total of 88 patients with end-stage renal disease undergoing preoperative arteriovenous fistula while with a poor vascular condition in Department of Nephrology were randomly divided into 4 groups:the patients in group A were treated with strong hand grip strength group(force 15.1 kg20.0 kg),group B was mid-range group(forced 10.1 kg-15.0 kg),group C was weak group(5.0 kg-10.0 kg),and group D was hand-fist group.At the time before the intervention,2 weeks and 4 weeks after intervention,blood vessel Doppler ultrasonography was performed to observe the changes of radial artery blood flow velocity and cephalic vein vessel diameter.Results:There was no statistically significant difference in radial artery blood flow velocity among the four groups before the intervention and 2 weeks after intervention(P＞0.05).There was a statistically statistically significant difference in blood flow velocity after 4 weeks of exercise(P＜0.05).There was no statistically significant difference in the cephalic vein vessel diameter among the four groups before the exercise(P＞0.05).There was a statistically significant difference in the cephalic vein vessel diameter among the four groups at the time of 2 weeks and 4 weeks after the exercise(P＜0.05).Conclusions:For patients undergoing pre-operative arteriovenous fistula but with a poor vascular condition which can not meet the requirements of surgery,early exercise for improving the function of grip could improve the cephalic vein vessel diameter and radial artery blood flow velocity at a certain level.