尿激酶联合肝素钠治疗血液透析患者内瘘栓塞的护理  

Nursing application of urokinase with heparin sodium to management of the internal fistula thrombosis in hemodialysis

作　　者：潘春英 汪宏[1] PAN Chunying;WANG Hong(Department of Hemodialysis,People′s Hospital of Huangshan City,Huangshan 245000,China)

机构地区：[1]黄山市人民医院血液透析科

出　　处：《皖南医学院学报》2019年第5期496-498,共3页Journal of Wannan Medical College

基　　金：黄山市科技计划项目(2017KN-04)

摘　　要：目的:探讨动脉穿刺泵入尿激酶联合全身使用肝素钠治疗血液透析患者自体动静脉内瘘栓塞的护理技巧。方法:采用7号头皮针经动静脉内瘘吻合口上方2~3cm处行动脉离心顺血流穿刺,用尿激酶30万U加生理盐水40mL微泵泵入局部溶栓,同时经外周静脉滴注肝素钠12500U加入生理盐水100mL进行全身抗凝治疗,治疗前对动脉搏动及穿刺点进行评估确定,治疗中密切观察局部及全身有无并发症的发生,并采取针对性的护理措施。结果:对54例自体动静脉内瘘栓塞患者共进行64例次溶栓抗凝治疗,55例次溶栓成功、内瘘恢复血流,成功率85.94%,9例次溶栓无效后经手术取栓及内瘘重建治疗恢复内瘘功能;仅2例次出现原内瘘穿刺点出血、6例次出现穿刺局部肿胀的并发症。结论:血液透析患者自体动静脉内瘘栓塞后早期采取局部尿激酶溶栓联合全身使用肝素钠抗凝治疗,操作简便,创伤小,费用低,通畅率高,而治疗前的正确评估及一针穿刺成功则是提高内瘘溶栓成功的关键。Objective: To investigate the nursing skills of applying urokinase with heparin sodium to treatment of naive fistula thrombosis by arterial infusion pump in patients undergoing hemodialysis. Methods :Centrifugal vein-puncture was initially performed using size 7 needle along the arterial blood flow at 2-3 cm proximal to the anastomotic stoma of arteriovenous fistula,into which 300 000 U urokinase dissolved in 40ml saline was pumped to facilitate local thrombolysis.Another 12 500 U urokinase was dissolved in 100 mL saline for systemic anticoagulation by peripheral intravenous infusion.Arterial beat and puncturing site were evaluated before therapy,and either local or systematic complications were closely observed in treatment.Any adverse events were managed by corresponding nursing procedures. Results :A total of 64 events of anticoagulation were carried out in the 54 patients with naive arteriovenous fistula embolization,and successful thrombolysis and recovered blood flow at the fistula were observed in 55 events(85.94%).Nine patients of thrombolysis failure required thrombectomy and fistula reconstruction.Hemorrhage at the naive fistula was seen in only 2 patients,and local swelling at the puncturing site occurred in 6. Conclusion :Early local use of urokinase combined with heparin sodium in the treatment of naive arteriovenous fistula embolization in patients undergoing hemodialysis may be simple performance,and leads to minor invasion and low cost,yet higher patency rate.However,correct evaluation before treatment and successful needle puncture are the key to improve the outcomes of thrombolysis at the fistula.

关 键 词：尿激酶 肝素钠 内瘘栓塞 护理 

分 类 号：R473.55[医药卫生—护理学]