动静脉内瘘血栓形成的危险因素以及尿激酶溶栓联合多磺酸粘多糖治疗的效果  

Factors affecting arteriovenous fistula thrombosis in hemodialysis patients and analysis of the effect of urokinase thrombolysis combined with mucopolysaccharide polysulfate

作　　者：邱乐乐 向晶[1] 冯哲[1] 曾鹂[1] 程艳爽[2] Qiu Lele;Xiang Jing;Feng Zhe;Cheng Yanshuang(Department of Nephrology,the First Medical Centre,Chinese PLA General Hospital,Beijing 100853,China)

机构地区：[1]解放军总医院第一医学中心肾脏病科,北京100853 [2]解放军总医院第一医学中心肝胆外科,北京100853

出　　处：《中华保健医学杂志》2020年第3期109-111,共3页Chinese Journal of Health Care and Medicine

基　　金：国家自然科学基金(81670694);解放军总医院科技创新苗圃基金(18KMM50)。

摘　　要：目的探讨影响血液透析患者动静脉内瘘血栓形成的因素,以及尿激酶溶栓联合多磺酸粘多糖治疗的效果。方法选取014年1月~2018年12月在解放军总医院以动静脉内瘘为血管通路的血液透析患者295例,按照有无发生动静脉内瘘血栓分为血栓组60例和非血栓组235例,按照随机数表法将血栓组分为观察组(尿激酶溶栓联合多磺酸粘多糖)和对照组(尿激酶)各30例。分析血液透析患者动静脉内瘘血栓形成的影响因素,以及尿激酶溶栓联合多磺酸粘多糖治疗的效果。结果经单因素分析,糖尿病、收缩压(SBP)、总胆固醇(TCHO)、低密度脂蛋白胆固醇(LDL-C)、空腹血糖(GLU)、血红蛋白(Hb)、D-二聚体(D-D)、超滤率是血液透析患者动静脉内瘘血栓形成的影响因素(P <0.05)。经多因素二元Logistic分析,糖尿病,SBP降低,LDL-C、D-D升高,超滤率增高是血液透析患者动静脉内瘘血栓形成的危险因素(P <0.05)。观察组溶栓成功率为87.80%,明显高于对照组的67.35%(P <0.05);观察组不良反应发生率为16.67%,与对照组的23.33%比较,差异无统计学意义(P﹥0.05)。结论对有危险因素的血液透析患者需早期预防,严格把握超滤率。尿激酶溶栓联合多磺酸粘多糖治疗血液透析患者动静脉内瘘血栓的效果优于单独使用尿激酶。Objective To explore the influencing factors of arteriovenous fistula thrombosis in patients with hemodialysis,and the effect of urokinase thrombolysis combined with mucopolysaccharide polysulfate.Methods A total of 295 hemodialysis patients with arteriovenous fistulas as vascular access in our hospital were selected.According to the presence or absence of arteriovenous fistula thrombus,there were 60 cases in the thrombus group and 235 cases in the nonthrombotic group.There were 30 cases in the study group(Urokinase thrombolysis combined with mucopolysaccharide polysulfate)and the control group(Urokinase).To analyze the influencing factors of arteriovenous fistula thrombosis in hemodialysis patients,and the effect of urokinase thrombolysis combined with mucopolysaccharide polysulfate.Results After univariate analysis,diabetes,systolic blood pressure(SBP),total cholesterol(TCHO),low-density lipoprotein cholesterol(LDL-C),fasting blood glucose(GLU),and hemoglobin(Hb),D-dimer(D-D),and ultrafiltration rate are the influencing factors of arteriovenous fistula thrombosis in hemodialysis patients(P<0.05).By multivariate binary logistic analysis,diabetes,SBP,LDL-C,D-D increased,and ultrafiltration rate were risk factors for arteriovenous fistula thrombosis in hemodialysis patients(P<0.05).The thrombolysis success rate in the study group was 87.80%,which was significantly higher than the control group’s 67.35%(P<0.05);The incidence of adverse reactions in the study group was 16.67%,compared with 23.33%in the control group,and the difference was not statistically significant(P>0.05).Conclusion Patients with risk factors for hemodialysis need early prevention and strictly control the ultrafiltration rate.The effect of urokinase thrombolysis combined with mucopolysaccharide polysulfate on arteriovenous fistula thrombus in hemodialysis patients is better than that of urokinase alone.

关 键 词：血液透析 动静脉内瘘 血栓 尿激酶溶栓 多磺酸粘多糖 

分 类 号：R543[医药卫生—心血管疾病]