| Objective:End-stage renal disease is one of the most common and frequently-occurring diseases in clinic.It is another chronic disease with heavy burden after hypertension and diabetes mellitus.Arteriovenous fistula is the preferred type of permanent vascular access for maintenance hemodialysis in patients with end-stage renal disease.Compared with the management of hypertension and diabetes,the management of arteriovenous internal fistula in patients with end-stage renal disease is not standardized,and the degree of attention is not good.The early power loss of arteriovenous fistula can reach 60%,which is far from enough to rely only on the management of specialist doctors.This study explores the influence of fasudil on the level of inflammatory factors and the clinical effect of fistula maturation by integrating the management ideas of general practitioners,to increase the success rate of patients and extend the vascular access.It provides a basis for use and lays a theoretical foundation for general practitioners to manage patients with end-stage renal disease after arteriovenous fistula.Methods:Forty-four patients with chronic renal failure who met the criteria were selected in the Department of Nephrology,Affiliated Hospital of North Sichuan Medical College from May1,2020 to July31,2020.Patients were included in the experimental group and the control group according to the order of operation.The experimental group(fasudil group)was given sodium chloride injection 100ml and fasudil hydrochloride 30mg once a day for 7 days.The observation group was only treated with sodium chloride injection 100ml.Patients in both groups were based on the management of general practitioner.While hypertension,anemia,calcium and phosphorus metabolism disorders and other complications were corrected.Complication such as hypertension,anemia and disorder of calcium and phosphorus metabolism were also corrected in both groups.The leukocyte,platelet,red blood cell,hemoglobin,hematocrit,Cr,BUN,AST,ALT and albumin were taken before and after treatment.The serum levels of CRP,IL-6,IL-1β and TNF-α were compared on T0(preoperative),T1(postoperative and before the treatment(T1)and 7 days after drug treatment(T2).The fistula flow,radial artery diameter,cephalicvein diameter,fistula success and complications were followed up at 1,4 and 12 weeks after operation.The time of initial fistula use and dialysis flow were followed up 12 weeks after operation.Results:1.Basic information of two groups of patients:A total of 44 patients were included in the study,including 24 in the experimental group and 20 in the control group.In the experimental group,there were 19 males and 5 females,with an average age of 53.42 years old.There were 8 cases of chronic glomerulonephritis,7 cases of diabetic nephropathy,3 cases of hypertensive nephropathy,2 cases of nephrotic syndrome,1 case of polycystic kidney,1 case of lupus nephritis,and 2 cases of unknown others.In the control group,there were 14 males and 6 females,with an average age of about 56.40 years old.There were 6 cases of chronic glomerulonephritis,5 cases of diabetic nephropathy,4 cases of hypertensive nephropathy,2 cases of nephrotic syndrome,1 case of polycystic kidney,1 case of lupus nephritis,and 1 case of other or unknown.There was no statistical significance in gender,age,smoking status,BMI,primary disease,blood pressure,blood lipid,coagulation function,fistula location and vascular diameter between the two groups(P>0.05).2.Comparison of inflammatory indexes between the two groups:Comparison of AVF(T0)preoperative,the first day after surgery before drug treatment(T1),and 7 days after drug treatment(T2)inflammatory factor.Within the same group,the serum levels of CRP,IL-6,IL-1β and TNF-α in T1 in two groups were higher than those in T0(P<0.05),after treatment with drugs,the levels of CRP,IL-6,IL-1β and TNF-α in T2 were lower than that in T1,but slightly higher than that in T0(P<0.05);Compared with the control group,the serum levels of CRP,IL-6,IL-1β and TNF-α in T0 and T1 of the experimental group were not statistically significant(P>0.05),but the average levels of CRP,IL-6,IL-1 βand TNF-α in T2 of the experimental group were lower than those in the control group,and the difference was statistically significance(P<0.05).3.Compare two groups of patients with mature relevant indicators:fistula flow and arteriovenous fistula diameter were compared at the 1st,4th and 12th week after surgery.The fistula flow and the cephalic vein diameter in the two groups were gradually increasing with time.The average level of fistula flow and cephalic vein diameter in 4 weeks was higher than that in the first week and lower than that in the 12th week(P<0.05).There was no significant increase in radial artery diameter over time in 2 groups(P>0.55).Compared with the control group,the fistula flow and cephalic vein diameter were higher in the experimental group at 1,4,and 12 weeks(P<0.05),but the radial artery diameter did not change significantly(P>0.05).At the 12th week after surgery,the time of initial use of fistula dialysis in the experimental group was significantly shorter than that in the control group(P<0.05),and the average dialysis flow was higher than that in the control group(P<0.05).4.Comparison of the success rate and complications of internal fistula between the two groups:Kaplan-Meier survival curve analysis of the two groups showed that the success rate of internal fistula in the experimental group was 92.3%higher than that in the control group(80%)at the 12th week after surgery,with no statistical significance(P>0.05).The cumulative success rates of the experimental group at week 1,4 and 12 were 96.2%,96.2%and 92.3%,while those of the control group at week 1,4 and 12 were 92.0%,84.0%and 80.0%.At the first week after operation,there was fistula thrombosis in 1 patient in the experimental group and 2 patients in the control group.At the 4th week after operation,there was 1 patient of fistula thrombosis in the control group,1 patient of fistula anastomotic stenosis in the control group,and none in the experimental group.At the 12th week after operation,1 patient in the experimental group had fistula anastomotic stenosis,and 1 patient in the control group had hemangioma at the fistula.5.Safety analysis of fasudil5.1 Serological comparison between the two groups:Before and after treatment,there was not statistically significant in leukocyte,platelet,red blood cell,hemoglobin,hematocrit,Cr,BUN,AST,ALT and albumin in the two groups(P>0.05).5.2 Comparison of adverse reactions between the two groups:a small amount of bleeding occurred in the operative limb of 3 patients in the experimental group,and 1 patient in the control group.All patients in the two groups were given point pressure to stop bleeding and keep the wound accessories dry,and there was no obvious bleeding.one patient in the experimental group had limb swelling on the operative side,and the control group had two patients.The patients were instructed to raise the affected limb and slightly clench their fists to move their fingers,the limb swelling of all patients gradually disappeared after 1 week.No wound infection occurred in both groups during drug intervention(χ2=0.023,P>0.05).Conclusion:1.By comparing the changes in the levels of inflammatory factors in the blood of patients undergoing AVF surgery before and after surgery,it is suggested that the level of inflammation in patients after AVF surgery is significantly increased.Fasudil,as a new ROCK-specific inhibitor,can effectively reduce the level of inflammatory factors after surgery.2.The application of fasudil after AVF can promote the maturation of internal fistula,improve the maturation rate of internal fistula,and reduce complications,and there is no obvious adverse reaction of fasudil in clinical application. |
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