| Research Purpose:The purpose of this study is to construct a set of limb function exercise programs after autogenous arteriovenous fistula(AVF)plasty,and select the red light treatment(with,without)and limb function exercise(with,without)for a 2×2 cross combination using the factorial design analysis method.Comparing the maturation situation of ultrasound and physical is to determine the optimal intervention methods for this study to promote maturation of AVF in order to improve the effect of AVF in maturation and increase the rate of maturation.Research Methods:1.Construction a limb functional exercise program:A preliminary limb functional exercise program was formed through literature review,then experts demonstrated and pre-experiments that a scientific and effective limb functional exercise program.2.To search for the optimal intervention methods for this study: Patients who underwent AVF plasty in the operating room of the Kidney Disease Center of the three level of first-class hospital in Zhejiang Province from June 2020 to January 2021 were selected as the research objects.Using the Factor factorial design analysis method,Factor 1: red light treatment setting two levels are with and without respectively.Factor 2:limb function exercise setting two levels are with and without respectively.The patients were randomly divided into groups A,B,C and D.Group A:routine postoperative nursing;Group B:received a limb functional exercise program under routine postoperative nursing;Group C:received red light therapy under routine postoperative nursing;Group D:received red light therapy combined with a limb functional exercise program under routine postoperative nursing.Collect the patient’s the general data and ultrasound evaluation index before AVF plasty,and measurement ultrasonic mature index,including draining vein(DV)diameter,DV blood flow,DV depth from the skin surface;physical maturation indications(tremor,vascular elasticity and vascular pulsation),DV Wall thickness and the occurrence of complications after two to eight weeks postoperatively.Research Results:In this study,the data of 108 included patients(Group A:26 cases,Group B:27 cases,Group C:28 cases,Group D:27 cases)were statistically analyzed,and the results were as follows.1.Ultrasonic maturation:(1)DV diameter:(1)Results of inter-group and pairwise comparison among the four groups:there were statistically significant differences in the DV diameter among the four groups after two to eight weeks postoperatively(P<0.001).Results of pairwise comparison:There were statistically differences between group A and B,C,D after two weeks postoperatively(P<0.05).No statistically differences between group B and C(P=0.057>0.05),and both have statistically differences with group D(P<0.05).So that after two weeks postoperatively DV diameter among four groups was sorted in order from large to small was D>C=B>A;There was statistically differences in pairwise comparison among four groups after four to eight weeks postoperatively(P<0.05).So that the DV diameter in four groups was sorted in order from large to small was D>C>B>A.(2)Results of factorial design analysis:The changes of the DV diameter among the four groups had a time effect,and there was a statistically significant difference in the DV diameter at each point in time(P<0.001).Different measurement times had interactive effect on the DV diameter with red light treatment and limb functional exercise respectively(P<0.001,P<0.001).The inter-group effect analysis showed that red light treatment and limb functional exercise had significant main effect on the DV diameter(P<0.001,P=0.001<0.01),but no interaction effect on the DV diameter(P=0.964>0.05).(2)DV blood flow:(1)Results of inter-group and pairwise comparison among the four groups:there were statistically significant differences in the DV blood flow among the four groups after two to eight weeks postoperatively(P<0.001).Results of pairwise comparison:There were statistically differences between group A and B,C,D after two weeks postoperatively(P<0.05).No statistically differences between group B and C(P>0.05).No statistically differences between group C and D(P>0.05),and there was statistically difference between group B and group D(P<0.05).There was statistically differences in pairwise comparison among four groups after four to eight weeks postoperatively(P<0.05).So that the DV blood flow among four groups was sorted in order from large to small was D>C>B>A.(2)Results of factorial design analysis:The changes of DV blood flow among the four groups had a time effect,and there was a statistically difference in the DV blood flow at each point in time(P<0.001).Different measurement times had interactive effect on the DV blood flow with red light treatment and limb functional exercise respectively(P<0.001,P=0.011<0.05).The inter-group effect analysis showed that red light treatment and limb functional exercise had significant main effect on the DV blood flow(P<0.001,P=0.001<0.01),but no interaction effect on the DV blood flow(P=0.971>0.05).(3)DV depth from the skin surface:(1)Results of inter-group and pairwise comparison among the four groups:there was no statistically differences in the DV depth from the skin surface among the four groups after two to eight weeks postoperatively(P=0.608>0.05,P=0.520>0.05,P=0.507>0.05,P=0.558>0.05).(2)Results of factorial design analysis:The changes of DV depth from the skin surface in the four groups had a time effect,and there was a statistically significant difference in the DV depth from the skin surface at each point in time(P<0.001).Different measurement times had interactive effect on the DV depth from the skin surface with red light treatment and limb functional exercise respectively(P=0.416>0.05,P=0.697>0.05).The inter-group effect analysis showed that red light treatment and limb functional exercise had no significant main effect on the DV depth from the skin surface(P=0.486>0.05,P=0.774>0.05),and no interaction effect on the DV depth from the skin surface(P=0.267>0.05).2.Physical maturation:Results of inter-group and pairwise comparison among the four groups:there were statistically significant differences in the four groups with the tremor(P=0.008<0.01).Results of pairwise comparison:No statistically differences between group A and D(P>0.05).There were no statistically differences in vascular elasticity and vascular pulsation among the four groups(P=0.507>0.05,P=0.207>05).3.Maturation rate:(1)Ultrasonic maturation rate:There were statistically significant differences in the ultrasonic maturation rate at four,six and eight weeks postoperatively among the four groups(P<0.001,P<0.001,P=0.023<0.05).Results of pairwise comparison:After Four weeks postoperatively,there were statistically differences between group A and B,C,D(P<0.05).There were statistically differences between group B and A,D(P>0.05),and the same as group C and A,D.So that the order of ultrasonic maturation rate from high to low among the four groups was D>C>B>A.After six weeks postoperatively,There was statistically difference between group A and group C,D(P>0.05),and.the same as group B and D(P>0.05).There was no statistically difference in other pairwise comparison results(P>0.05).Only group A and group D had statistical difference after eight weeks postoperatively(P<0.05).(2)Physical maturation rate:There was statistically significant difference in the physical maturation rate among the four groups(P=0.008<0.01).Results of pairwise comparison:The differences between group A and group D was statistically significant(P<0.05).4.DV Wall thickness:(1)Results of inter-group and pairwise comparison among the four groups:There was statistically significant difference among the four groups in the DV Wall thickness after two to eight weeks postoperatively(P=0.001<0.01,P=0.002<0.01,P<0.001,P<0.001);Results of pairwise comparison:Two weeks after operation,there were statistically differences between group A,B and group D(P<0.05).The same as group B and group D.There was no statistically differences in the other pairwise comparisons after two to eight weeks postoperatively(P<0.05).(2)Results of factorial design analysis:The changes of DV Wall thickness among the four groups had a time effect,and the difference of DV Wall thickness at each time point was statistically significant(P<0.001),different measurement time had no interaction effect with red light therapy and limb functional exercise on the DV Wall thickness(P=0.691>0.05,P=0.768<0.05).Inter-group effect analysis showed that red light therapy and limb functional exercise had significant main effects on the DV Wall thickness(P<0.001,P=0.030<0.05),there was no interaction effect on the DV Wall thickness(P=0.979 >0.05).5.Related complications:There was no statistically difference in incidence of infection,stenosis and thrombosis among the four groups(P=0.741>0.05,P=0.484>0.05,P=0.486>0.05).Research Conclusion:1.Red light therapy,limb functional exercise and the combination of them all had a good effect on expansion of DV diameter and promotion of DV blood flow.The combined effect was better than that of single red light therapy or limb functional exercise.Red light therapy combined with limb functional exercise improved the early postoperative ultrasound maturation rate and shortened the maturation time of the AVF,but both red light therapy and limb functional exercise had little effect on the DV depth from the skin surface.2.Red light therapy combined with limb functional exercise has little effect on the tremor,vascular elasticity and vascular pulsation.Only red light therapy combined with limb functional exercise has obvious effect on tremor compared with conventional postoperative nursing.3.Red light therapy,limb functional exercise and the combination of them had a good effect on thickness of DV Wall thickness.The combined effect was better than that of single red light therapy or limb functional exercise.4.There was no significant difference in the incidence of AVF complications between red light treatment,limb functional exercise and the combination of them,which indicated that red light therapy,limb functional exercise and the combination of them did not increase the incidence of postoperative complications.In conclusion,red light therapy combined with limb functional exercise has the best effect on DV diameter expansion,DV blood flow improvement and DV wall thickening on the basis of ensuring the safety of AVF.It is worthy to promoting and applying in clinical that the early postoperative ultrasound maturation rate will be improved and the maturation time of the AVF will be shortened. |
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