如意金黄散外敷与喜疗妥治疗动静脉内瘘血肿的疗效比较.docVIP

如意金黄散外敷与喜疗妥治疗动静脉内瘘血肿的疗效比较 　　[摘要] 目的 探讨如意金黄散外敷及喜疗妥涂抹治疗动静脉内瘘血肿的效果。 方法 将132例动静脉内瘘使用过程中发生皮下血肿的患者随机分为两组，其中对照组66例，发生血肿后常规按压，止血后冰袋冷敷血肿处，24 h后使用毛巾进行局部湿热敷，于热敷后在血肿局部涂抹喜疗妥软膏并轻轻按摩5～10 min，直至药膏全部经皮肤吸收，每日进行3～4次。研究组66例，血肿发生24 h后将如意金黄散用蜂蜜或清茶调匀成稀泥状外敷，每天更换2～3次。观察两组临床疗效。 结果 对血肿范围5～10 cm及10 cm，研究组在血肿面积缩小等方面的疗效明显优于对照组，差异有统计学意义（P10 cm的皮下血肿消散、吸收的疗效显著，操作简便，值得推广。 　　[关键词] 如意金黄散；动静脉内瘘；血肿 　　[中图分类号] R459.5 [文献标识码] B [文章编号] 1673-9701（2015）15-0048-03 　　[Abstract] Objective To compare the clinical efficacy between Ruyi golden powder with hirudoid for arteriovenous fistula hematoman. Methods A total of 132 cases with subcutaneous hematoma in arteriovenous fistula were divided into two groups randomly. 66 cases of control group was treated with conventional pressure， icepack being applied after hemostasis， local wet towels fomentation after 24 hours， then hirudoid cream topical smearing with massage for 5-10 minutes until creams being absorbed through the skin， with 3-4 times per day. 66 cases of study group were treated with Ruyi golden powder with tea or honey to mix thoroughly into the mud like for local application in 24h of hematoma formation， with 2-3 times per day. Clinical efficacy of two groups was compared. Results In range of 5-10 cm and range of 10 cm， hmatoma size reduction of study group was better than that in the control group（P10 cm subcutaneous hematoma dissipated， absorption is significant， and easy to operate， worthy of clinical promotion. 　　[Key words] Ruyi golden powder； Arteriovenous fistula； Hematoma 　　血液透析（hemodialysis，HD）目前仍然是慢性肾功能不全患者赖以生存的肾替代治疗方法。而透析用血管通路则成为患者必不可少的“生命线”[1]。血管通路是保证血液透析治疗顺利进行以及影响血液透析效果的重要因素。维持性血液透析（maintenance hemodialysis，MHD）需建立慢性血管通路，即永久性血管通路，以保证透析的充分性，延长MHD患者的生存期。永久性血管通路包括：自体动静脉内瘘（outogenous arteriovenous fistula，AVF）、移植血管血液透析通路、带涤纶环的长期导管。其中AVF是NKF-K/DOQI临床实践指南推荐的血液透析患者首选的永久性血管通路。预计目前使用自体动静脉内瘘的患者超过66%，血管通路通畅，血流量足够才能维持正常血透[2]。而内瘘使用过程中发生的血肿严重影响其使用。对于内瘘血肿的处理，目前临床上多采用拔针24 h后使用毛巾湿热敷，于热敷后，在血肿局部涂抹喜疗妥软膏并轻轻按摩5～10 min，直至药膏全部经皮肤吸收，每日进行3～4次，血肿消散及疼痛减轻的效果不是很