急性动静脉内瘘血栓形成的置管溶栓治疗

目的探讨透析用动静脉内瘘急性血栓形成的置管溶栓治疗的方法及临床价值。方法 2008年1月至2011年1月治疗50例患者发生的67例次急性动静脉内瘘血栓形成。经股动脉插管行上肢动脉造影明确诊断,先用泥鳅导丝行血栓闭塞段导丝穿通术,然后经导管团注尿激酶25万u,如果血栓不能完全清除则保留导管持续泵入尿激酶1～3 d,置管溶栓治疗后24、48、72 h行造影复查,如血管造影显示血栓完全溶解则终止溶栓。结果 67例次急性动静脉内瘘急性血栓形成中,8例次经过尿激酶团注治疗透析道恢复通畅;在置管溶栓后24、48、72 h造影复查时分别有34例次、18例次及5例次显示血栓完全溶解而停止溶栓治疗;2例次溶栓治疗失败。所有病例在置管溶栓过程中均未出现肺栓塞及出血等并发症。结论置管溶栓治疗急性动静脉内瘘血栓形成具有操作简便、疗效肯定、微创、安全的特点,具有较高的临床应用价值。

Transcatheter thrombolysis treatment for acute thrombosis in arteriovenous fistulas in hemodialysis patient

Objective To assess the clinical value of transcatheter thrombolysis in treating acute arteriovenous fistula thrombosis in hemodialysis patients and to discuss its technical points.Methods During the period from Jan.2008 to Jan.2011,67 times of acute arteriovenous fistula thrombosis occurred in 50 hemodialysis patients.The diagnosis was confirmed by angiographic findings.First the guide-wire was inserted and pushed forward to pass through the thrombus,then bolus injection(pulse spray) of urokinase(250,000 units) through catheter was performed.If the thrombus could not be cleared away,transcatheter micro-pump continuous infusion of urokinase was employed for 1-3 days until the thrombosis was completely dissolved,which was confirmed by angiographic re-examination at 24,48 and 72 hours after the start of thrombolysis.Results Of the total 67 times of acute arteriovenous fistula thrombosis,the arteriovenous fistula reopened in 8 cases after transcatheter thrombolysis with pulse spray of urokinase.At 24,48 and 72 hours after the initiation of thrombolysis treatment,the thrombus was completely dissolved in 34,18 and 5 cases,respectively.The thrombolysis treatment failed in two cases.No serious complications such as pulmonary embolization,hemorrhage,etc.occurred during the therapeutic course.Conclusion For the treatment of acute arteriovenous fistula thrombosis in hemodialysis patients,transcatheter thrombolysis is an easily-manipulated,effective,minimally-invasive and safe technique.Therefore,it is of great clinical value.