血管穿刺溶栓治疗血液透析患者内瘘血栓临床效果观察

目的 观察内瘘穿刺溶栓治疗内瘘血栓的疗效及并发症.方法 因血栓形成动静脉内瘘失功的14例血液透析患者共17例次.其中自体血管内瘘13例次,人造血管内瘘4例次.经自体内瘘静脉置入深静脉导管或将留置针置入人造血管内,经上述通路向内瘘血栓注入尿激酶(25～75)万U/d进行溶栓治疗.结果 治疗后11例次内瘘血管在3～25小时内溶通,平均(11.82±7.31)小时,成功率为64.7%;6例次溶栓失败.溶栓成功的患者治疗前血栓形成时间(8.27±7.35)小时]明显短于不成功者(29.33±21.30)小时].6例自体动静脉内瘘患者在溶栓后出现轻度的前臂肿胀.所有患者均未出现身体器官的栓塞现象.结论 内瘘血管穿刺溶栓治疗血栓形成是一种经济、有效、安全的方法.

Observation on the clinical effect of intravascular thrombolytic therapy of arteriovenous internal fistula thrombosis in hemodialysis patients

To investigate the curative effect and complications of intravascular thrombolytic therapy of acute arteriovenous internal fistula thrombosis in hemodialysis patients. Seventeen acute arteriovenous internal fistula thromboses occurred in 14 dialysis patients underwent hemodialysis.Among those patients with arteriovenous internal fistula thromboses,there were 12 persons with autogenous arteriovenous internal fistulas and 2 individuals with artificial arteriovenous internal fistulas.The acute arteriovenous internal fistula thromboses were treated with Urokinase（25～75）10000 U/d throng a catheter dwelling in the vein of arteriovenous internal fistula or retained needles inserted in artificial arteriovenous internal fistulas. Eleven cases obtained recanalization of arteriovenous fistulas in（11.82±7.31）hours an average.The recanalization rate was 64.7%.Six cases failed in thrombolysis.The time of thrombogenesis before treatment in the recanalization group（8.27±7.35）hours]was significantly shorter than that without recanalization（29.33±21.30）hours].Six patients experienced mild swollen forearm for a short period of time.No organic thrombogenesis was found in all patients. Intravascular thrombolytic treatment is an economical,effective and safe way in the treatment of acute arteriovenous internal fistula thrombosis.