改良药物机械除栓在维持性血液透析患者人工血管内瘘血栓治疗中的应用  

Efficacy of modified pharmacomechanic thrombolysis for endovascular treatment of thrombosed arteriovenous grafts

作　　者：张丽红[1] 詹申 肖光辉[1] 王玉柱[1] 刘文虎[2] Zhang Li-hong;Zhan Shen;Xiao Guang-hui;Wang Yu-zhu;Liu Wen-hu(Department of Nephrology,Haidian Hospital(Beijing Haidian Campus,Peking University Third Hospital),Beijing 100080,China;Department of Nephrology,Affiliated Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China)

机构地区：[1]北京市海淀医院(北京大学第三医院海淀院区)肾内科,100080 [2]首都医科大学附属友谊医院肾内科,北京100050

出　　处：《临床肾脏病杂志》2021年第2期89-94,共6页Journal Of Clinical Nephrology

基　　金：北京市医院管理局临床医学发展专项经费资助(ZYLX201824);2020年北京市海淀医院院级基金项目(KYM2020001)。

摘　　要：目的探索改良药物机械除栓在维持性血液透析患者人工血管内瘘血栓治疗中的安全性、有效性。方法选择2018年8月1日至2019年9月30日因人工血管内瘘血栓形成来我院就诊治疗行改良药物机械除栓治疗的患者,收集基线数据、手术信息,并随访180 d,观察术后通畅情况,分析影响术后原发通畅率的因素。结果共105例患者进行146例次除栓,手术时间(66.65±10.08)min,血流开通时间(16.75±4.28)min,尿激酶用量(27.91±8.05)万U;技术成功率97.94%,临床成功率97.26%,总并发症发生率6.85%,未出现症状肺栓塞及动脉栓塞。干预后30 d、90 d、180 d原发通畅率分别为91.55%、70.42%、42.95%;Cox分析显示高胆固醇(HR 1.08,P=0.02)、人工血管类型(HR 2.14,P<0.01)、合并狭窄(HR 5.23,P<0.01)是影响术后通畅的因素。结论改良药物机械除栓有效,操作简单,用时短,安全性良好,值得临床推广。Objective To evaluate the efficacy and safety of the PMT technique in the treatment of thrombosed PAVA by analyzing the long-term patency.Methods Patients who were treated in our hospital for PAVA thrombosis from August 2018 to September 30,2019 were selected,and qualified patients were treated with modified pulsed-spray pharmacomechanical thrombolysis by the same surgeon.Baseline data and surgical information were collected and followed up for 180 days.Observe the postoperative patency and analyze the factors affecting the primary patency.Results A total of 105 patients underwent thrombectomy,with an average total operation time of(66.65±10.08)minutes,blood flow opening time of(16.75±4.28)minutes,and a dosage of urokinase of(27.9±8.05)ten thousand U.The technical success rate was 97.94%,and the clinical success rate 97.26%.The total complication rate was 6.85%,no symptoms pulmonary embolism and arterial embolism.The postoperative primary patency rates were 91.55%,70.42%,and 42.95%at 30,90,and 180 days,the postoperative primary assisted patency rates were 93.66%,82.39%,and 59.15%.Cox analysis showed high cholesterol(HR 1.08,P=0.02),type of vascular prosthesis(HR 2.14,P<0.01),and combined stenosis(HR 5.23,P<0.01)were the risk factors affecting the primary patency after PAVA thrombus intervention.Conclusion The modified PMT technique is effective and safe in endovascular treatment of thrombosed PAVA.It is time-saving,lower cost,simple operation,which is worthy of clinical application.

关 键 词：人工血管内瘘 血栓 腔内技术 药物机械除栓 通畅率 

分 类 号：R459.5[医药卫生—治疗学]