内瘘取栓在自体动静脉内瘘血栓闭塞患者中的疗效研究  

Comparative study between internal fistula thrombectomy and fibrinolytic therapy on patients with hemodialysis arteriovenous fistula re-thrombosis

作　　者：刘宗旸[1] 谢毅[1] 陈彦[1] 姜燕[1] 

机构地区：[1]贵州省肿瘤医院血液透析室,贵州贵阳550001

出　　处：《中国现代医学杂志》2015年第22期75-78,共4页China Journal of Modern Medicine

基　　金：黔科合LG字[2012]047号

摘　　要：目的分析内瘘取栓和溶栓治疗对血液透析患者自体动静脉内瘘血栓闭塞的治疗效果差异。方法选择在该院接受血液透析治疗并发生动静脉內瘘血栓的肾功能衰竭患者64例作为研究对象,按照随机数表法分为观察组和对照组,各32例。观察组接受内瘘取栓治疗,对照组接受溶栓治疗。比较两组患者的治疗后近期疗效、凝血功能及远期疗效差异。结果观察组患者接受内瘘取栓术治疗后的一次成功率高于对照组,瘘口直径及内瘘血流量均明显大于对照组患者(P<0.05)。观察组患者接受内瘘取栓治疗后的各凝血功能指标值均明显优于对照组患者(P<0.05)。观察组患者接受治疗后随访期内的再次闭塞比例,内瘘功能不良、手背肿胀、皮肤消化道出血等不良反应发生率均明显低于对照组,平均再次闭塞时间短于对照组患者(P<0.05)。结论内瘘取栓治疗可以有效提高动静脉内瘘再通率,在不明显影响患者凝血功能的前提下降低远期不良反应发生。[Objective] To compare internal fistula thrombectomy with fibrinolytic therapy on patients with hemodialysis arteriovenous fistula re-thrombosis. [ Methods ] Sixty-four patients with hemodialysis arteriovenous fis- tula re-thrombosis in our hospital were chosen as research objects, according to random indicator method all patients were divided into observation group （32 cases） treated with internal fistula thrombectomy, control group （32 cases） treated with fibrinolytic therapy. The short-term curative effect, blood coagulation function and long-term curative effect after treatment in two groups were compared. [ Results ] The success rate of observation group was higher than that of control group, stoma diameter and fistula blood flow were significantly greater than those in control group （P 〈 0.05）. Blood coagulation function indexes of observation group were significantly better than those of control group （P 〈 0.05）. The incidences of adverse reactions such as reocclusion during the follow-up period, internal fistula dys- function, hand swelling, skin and gastrointestinal bleeding, pulmonary embolism in observation group were signifi- cantly lower than those in control group, average reocclusion time was shorter than that of control group patients （P 〈 0.05）. [ Conclusions ] Internal fistula thrombectomy treatment can effectively increase the patency rate of arteriove- nous fistula, decrease the occurence of long-term adverse reactions in premise of not significantly affecting coagula- tion function.

关 键 词：血液透析 自体动静脉内瘘血栓闭塞 内瘘取栓 溶栓治疗 

分 类 号：R619.2[医药卫生—外科学]