动静脉内瘘超声引导下穿刺溶栓的疗效观察

目的探索一项安全有效的动静脉内瘘药物溶栓方法。方法将69例动静脉内瘘堵塞患者随机分成试验组35例和对照组34例,分别采用超声引导下直接穿刺血栓部位和传统溶栓方法,对两组患者的内瘘堵塞相关因素、溶栓效果、及溶栓后并发症进行比较。结果两组患者在年龄、内瘘使用时间、透析时间和血栓形成时间方面差异无统计学意义(P0.05)。试验组经溶栓后血管再通的患者是34例(97.2%),对照组经溶栓后血管再通的患者是20例(58.8%),两组内瘘再通率比较差异有统计学意义(÷2=19.76,P0.01)。试验组患者在溶栓后局部出血、局部血肿及局部疼痛并发症的发生率显著低于对照组,差异均有统计学意义(P0.01),两组患者均未出现发热、皮疹和肢体障碍等并发症。结论采用超声引导下直接穿刺血栓部位内瘘再通率高,溶栓后并发症少,具有穿刺定位准确、尿激酶用量小、局部药物浓度高等优势,此溶栓方法有较高的临床应用价值。

The effect of thrombolysis in arteriovenous fistula through puncture at thrombosis site guided by ultrasonography

Objective To explore a safe and effective route to apply thrombolysis drug for thrombosis in arteriovenous fistula. Methods A total of 69 cases with the blockage of arteriovenous fistula due to thrombosis were included in this study, and they were randomly assigned into two groups, control group treated with the traditional thrombolysis therapy （n=34）, or test group treated with modified thrombolysis anticoagulation through puncture at thrombosis site guided by ultrasonography （n=35）. Result The re-patency rate was 97.2% （34 cases） in test group, and was 58.8% （20 cases） in control group （P〈0.01）. The complications relating to thrombolysis such as local hemorrhages, hematoma and pain were less in test group than in control group （P〈0.01）. No fever, skin rashes and movement restriction in extremities occurred in both groups. Conclusion Puncture at thrombosis site guided by ultrasonography for thrombosis in arteriovenous fistula has the advantages of higher re-patency rate, less complication, and smaller dosage of urokinase used but higher localized drug concentration. Therefore, this method may have clinical application value.