超声引导尿激酶溶栓治疗维持性血液透析患者动静脉内瘘的临床观察  

Clinical observation on urokinase thrombolysis treatment of arteriovenous fistula guided by ultrasound in patients with hemodialysis

作　　者：王建爽[1] 杨文艳[1] 李令娟 王艳辉[3] 朱艳香[4] 

机构地区：[1]廊坊市第四人民医院超声科,河北廊坊0657003 [2]廊坊市第四人民医院心内科,河北廊坊0657004 [3]廊坊市第四人民医院内二科,河北廊坊065700 [4]廊坊市第四人民医院口腔科,河北廊坊065700

出　　处：《中国医学装备》2016年第4期78-81,共4页China Medical Equipment

摘　　要：目的:观察超声引导尿激酶溶栓治疗维持性血液透析(MHD)患者动静脉内瘘的疗效。方法:将动静脉内瘘堵塞的78例MHD患者,按照随机数字表法分为对照组及超声引导组,每组39例。对照组采用传统方法进行溶栓治疗;超声引导组在超声引导下直接穿刺血栓部位实施药物注射治疗。对两组D-二聚体(D-D)、纤维蛋白降解产物(FDP)、组织型纤溶酶原激活物(t PA)及纤溶酶原激活抑制物(PAI)等凝血纤溶指标、溶栓成功率及溶栓后并发症进行比较。结果:(1)治疗前两组D-D、FDP、t PA及PAI等凝血及纤溶指标相比,差异无统计学意义(t=0.39,t=0.30,t=0.26,t=0.15;P>0.05)。治疗后7 d超声引导组D-D及FDP升高幅度高于对照组,差异有统计学意义(t=3.61,t=4.03;P<0.01),两组t PA及PAI变化均不明显,差异无统计学意义(t=0.51,t=0.10;P>0.05);(2)对照组溶栓后再通25例,溶栓成功率为64.1%;超声引导组溶栓再通36例,溶栓成功率为92.3%,两组溶栓成功率相比,差异有统计学意义(x^2=9.10,P<0.01);(3)对照组溶栓所用时间和尿激酶用量分别为(5.6±2.8)d和(73.64±16.09)万IU,而超声引导组分别为(4.1±1.5)d和(41.35±19.12)万IU,超声引导组溶栓所用时间及尿激酶用量均少于传统对照组,两组相比差异有统计学意义(t=3.81,t=8.27;P<0.01);(4)对照组溶栓后局部疼痛、出血及血肿等并发症的发生率为25.6%,超声引导组的发生率为7.7%,两组溶栓后并发症发生率相比,差异有统计学意义(x^2=4.50,P<0.05)。结论:超声引导下对血液透析患者实施尿激酶溶栓治疗,血栓再通率高,溶栓后并发症少。Objective： To observe the effects on urokinase thrombolysis treatment of arteriovenous fistula guided by ultrasound in patients with maintenance hemodialysis. Methods： Seventy eight cases of hemodialysis patients with blockage of arteriovenous fistula were randomly divided into control group and ultrasound group, 39 cases in each group.The patients in control group was treated with the traditional thrombolysis therapy, those in ultrasound group was treated with urokinase thrombolysis through direct puncture at blood clots guided by ultrasound. The blood coagulation and fibrinolysis indicators such as D-D, FDP, tP A, PAI were detected in two groups. The success rates of thrombolysis and incidences of complications after thrombolysis were compared in two groups.The data were analyzed by using SPSS13.0 statistical software. Results：①The blood coagulation and fibrinolysis indicators such as D-D, FDP, tP A, PAI were no significant difference before treatment in two groups（t=0.39, t=0.30, t=0.26, t=0.15; P0.05）, the increasing amplitudes of D-D and FDP of ultrasound group were higher than those in control group at 7d after treatment（t=3.61,4.03, P0.01）. The changes of tP A and PAI were not obvious in two groups（t=0.51, t=0.10, P0.05）.②In control group, 25 cases was recanalized after thrombolysis, the thrombolysis success rate was 64.1%; 36 cases were recanalized and thrombolysis success rate was 92.3% in ultrasound group, the success rates of two groups were compared,the difference was statistically significant（x^2=9.10, P0.01）.③The thrombolysis time and dosage of urokinase was（5.6±2.8）d and（73.64±16.09）×10000 IU respectively in control group,（4.1±1.5）d and（41.35±19.12）×10000 IU respectively in ultrasound group, the differences were statistically significant（t=3.81, t=8.27; P0.01）.④In traditional control group,the incidence of local complications after thrombolysis such as pain, bleeding, hematoma was 23.1%, and was 7.7% in ultrasound group,the complications after

关 键 词：超声引导 尿激酶 溶栓 动静脉内瘘 血液透析 

分 类 号：R445.1[医药卫生—影像医学与核医学]