摘要
目的探讨局部尿激酶溶栓治疗血液透析患者动静脉内瘘血栓形成的疗效、影响因素及溶栓方案。方法回顾分析解放军总医院第一附属医院28例局部注射尿激酶治疗动静脉内瘘血栓形成患者的资料,观察疗效、影响因素及预后。结果28例共44例次溶栓,32例次溶通(72.7%)。溶通组血栓形成时间明显短于溶栓失败组,溶栓失败组附壁血栓形成发生率较溶通组高。溶通组有53.13%患者发生再栓塞,再栓塞的发生率与有无附壁血栓及原发病有关,糖尿病患者再栓塞的发生率高。尿激酶量≤60万IU溶通率达81.3%,栓塞≤36h溶通率达96.9%。2例溶通后16～48h再次栓塞,予尿激酶静脉滴注后再次溶通。常见的副作用为皮下血肿、鼻衄及牙龈出血。结论局部尿激酶溶栓治疗内瘘血栓形成操作简单,溶通率高达72.7%,有较高的临床应用价值。溶栓效果与血栓形成时间、有无附壁血栓及原发病有关。溶栓用尿激酶剂量以不超过60万IU为佳,溶栓时机应选择在内瘘栓塞24h以内,最多不超过36h。溶通后尿激酶及低分子肝素维持治疗可预防溶通后再发栓塞。
Objective To study the effect, therapeutic course and related factors of local urokinase application for the treatment of thrombosis in arteriovenous fistula in hemodialysis patients. Methods Local injection of urokinase was used in 28 hemodialysis patients for the treatment of thrombosis in fistula. Colored Doppler ultrasonography, hepatic and renal functions, prothrombin time and plasma fibrinogen were measured before and after the treatment. Results The thrombolytic treatment was used for the 28 cases in a total of 44 times, of which 32 times （72.7%） showed successful results. The proportion of male and climacteric female patients was higher in the successful cases than in the unsuccessful patients. Shorter thrombosis time and less mural thrombosis were found in the successful cases. However, thrombosis recurred in 53.13% of the successful patients. Recurrence of thrombosis was related to mural thrombosis and their complicated diseases, and was frequently seen in diabetic patients. When urokinase was used in a dose of less than 60,000 IU, successful results were found in 81.3% cases, and in 96.9% cases whose blocked fistula lasted less than 36 hours. In 2 cases, thrombosis recurred after opening of the blocked fistula for 16-48 hours. The usual side effects of urokinase were subcutaneous hemorrhage, epistaxis, and gingival bleeding, but gastrointestinal and cerebral bleeding were not encountered. Conclusion Urokinase is an effective thrombolytic measure for hemodialysis patients with thrombosis in autologous arteriovenous fistula. Its effectiveness is related to the existing time of thrombosis, the presence of mural thrombosis and the complication of diabetes. Urokinase is used in a dose of less than 60,000 IU. Thrombolysis treatment must be performed within 24-36 hours after the occurrence of thrombosis. After the treatment, patients should be observed for 72 hours. After reopening of the fistula, urokinase and low molecular heparin in the dose for maintenance therapy can prevent the fistula from thrombosis recurrence.
出处
《中国血液净化》
2007年第11期597-600,共4页
Chinese Journal of Blood Purification
关键词
尿激酶
动静脉内瘘
溶栓
血栓形成
Urokinase
Arteriovenous fistulae
Thrombolysis
Thrombus
