| Objective Maintenance hemodialysis(MHD)is one of the most important treatment methods for patients with end-stage renal disease(ESRD).Therefore,it is particularly important to establish the vascular access required by long-term hemodialysis in the wholestage of hemodialysis,which is considered to be the lifeline ofmaintenance hemodialysis patients.Autologous arteriovenous fistula(AVF)is the first choice of long-term vascular access both at home and abroad at present,but low AVF maturation rate has always been a difficult problem for clinicians.There is still no effective clinical methods to promote AVF maturation at present.Western medicine uses antiplatelet drugs such as aspirin,dipyridamole or anticoagulant therapy,but limited randomized study found that these drugs can not really effectively improve the AVF maturation.Traditional Chinese medicine hasits own characteristics and advantages in this regard.Blood-activiating and stasia-resolving medicine is thought to expand bloodvessel,improve local microcirculation,reduce platelet surface activity,inhibit the adhesion,aggregation and release of platelet,inhibit the synthase activity of thromboxane,with the role of thrombosis and dissolve thrombus.In addition,it can also eliminate oxygen free radicals,reducing vascular endothelial damage.Und er this background,we investigate whether blood-activiating and stasia-resolving medicine can shorten fistula maturation time,improve fistula maturation rate,improve the blood flow of AVF,reduce the incidence of postoperative complications and so on,so as to provide a new idea for clinical.Methods Comprehensive and systematic retrieval CNKI,Wanfang Data,VIP and other related databases through the computer,collecting clinical research Literatures published on promoting case studyof blood-activiating and stasia-resolving medicine in promoting AVF maturation,from January 1,2006 to December 31,2016.We selected the key words of "Traditional Chinese medicine" or "blood-activiating and stasia-resolving medicine" ? "internal arteriovenous fistula" or "vascular access",screening randomized controlled study,then the literatures were summarized and extracted relevant dataand.We use the Manager(Rev Man)version 5.2 software provided by Cochrane network to make meta analysis and systematic evaluation of the extracted experimental data.Results Finally,a total of 15 articles were included in the study,the results of the study were listed as the following 15 items.All of them include randomized control trials 1050,in which the experimentgroup is 524 cases,and the control group is 526 cases.Meta analysis results: 1.Comparison of two groups of patients with fistula maturation time: The study on the combined effects of MD=-10.31,95%CI[-13.34,-7.28].The research group and the control group comparison test after the merger,the difference was statistically significant(Z=6.67,P<0.00001).The results indicated that the experimental group in shortening the time of AVF maturation was better than the control group;2.Comparison of two groups of patients with internal fistula blood flow: The study on the combined effects of MD=57.69,95%CI[36.28,79.10].The research group and the control group comparison test after the merger,the difference was statistically significant(Z=5.28,P<0.00001).The results showed that the experimental group was better than the control group in improving the blood flow of AVF;3.Comparison of two groups of patients in the incidence of postoperative complications: The combined effects of OR=0.19,95%CI[0.08,0.42],were statistically different between the study group and the control group(Z=4.10,P<0.0001).The results indicated that the experimental group was better than the control group in reducing the incidence of postoperative complications;4.Comparison of two groups of patients with fistula maturation: In the experimental group,4 weeks,in the course of the 6 week,the 8 week and the 12 week,the AVF maturationwas was better thanthat of the control group,the difference was statistically significant(P=0.0006,0.04,0.007,0.0008);5.Comparison of two groups with success rate of first puncturation: The combined effects of OR=5.64,95%CI[1.92,16.55] were statistically different between the study group and the control group(Z=3.15,P<0.002).The results showed that the experimental group was better than the control group in the first puncture success rate.Conclusion Compared with western medicine,blood-activiating and stasia-resolving medicine has its own characteristics and advantages in promoting the AVF maturation.The use of blood-activiating and stasia-resolving medicine before and after AVF operation in patients with end-stage renal disease,can greatly shorten the AVF maturation time,improve the AVF maturation rate,increase blood flow of AVF,reduce the incidence of postoperative complications,improve the success rate of first puncturation,It is worthy of further research and clinical application. |
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