不同剂量尿激酶对维持性血液透析患者动静脉内瘘血栓的溶栓效果  

Thrombolytic effect of different doses of urokinase on arteriovenous fistula thrombosis in maintenance hemodialysis patients

作　　者：李明鹏[1] 陈德政[1] 张勇[1] 汪辉益 王明莉[1] 彭李[1] 魏萍[1] Li Mingpeng;Chen Dezheng;Zhang Yong;Wang Huiyi;Wang Mingli;Peng Li;Wei Ping(Department of Nephrology,the People's Hospital of Jianyang,Jianyang 641400,Sichuan,China;Department of Cardiovascular Surgery,the People's Hospital of Jianyang,Jianyang 641400,Sichuan,China)

机构地区：[1]简阳市人民医院肾内科,四川简阳641400 [2]简阳市人民医院心血管外科,四川简阳641400

出　　处：《血管与腔内血管外科杂志》2022年第10期1265-1269,1275,共6页Journal of Vascular and Endovascular Surgery

摘　　要：目的探讨不同剂量尿激酶对维持性血液透析(MHD)患者动静脉内瘘血栓的溶栓效果及凝血功能的影响。方法收集2017年6月至2021年6月简阳市人民医院收治的72例MHD发生动静脉内瘘血栓患者的临床资料,根据尿激酶剂量的不同将患者分为观察组(n=40,采用50万U尿激酶治疗)和对照组(n=32,采用25万U尿激酶治疗)。比较两组患者的溶栓治疗相关情况(48 h溶栓成功率、溶栓时间)、凝血功能指标[活化部分凝血活酶时间(APTT)、凝血酶时间(TT)、组织型纤溶酶原激活物(tPA)、纤溶酶原激活物抑制物(PAI)、纤维蛋白降解产物(FDP)和D-二聚体(D-D)水平]、氧化应激反应指标[一氧化氮(NO)、过氧化氢酶(CAT)、超氧化物歧化酶(SOD)水平]和溶栓治疗后并发症发生情况。结果观察组患者48 h溶栓成功率高于对照组患者,溶栓时间短于对照组患者,差异均有统计学意义(P<0.05)。溶栓后24 h、7 d,两组患者的tPA、FDP水平均高于本组溶栓治疗前,APTT、TT均长于本组溶栓治疗前,PAI、D-D水平均低于本组溶栓治疗前,且观察组患者的tPA、FDP水平均高于对照组患者,APTT、TT均长于对照组患者,PAI、D-D水平均低于对照组患者,差异均有统计学意义(P<0.05)。溶栓治疗后7 d,观察组患者的NO、SOD、CAT水平均明显高于对照组患者,差异均有统计学意义(P<0.01)。结论不同剂量尿激酶对MHD患者动静脉内瘘血栓均具有较好的治疗效果,但高剂量尿激酶起效更快,效果更优,不但能够减少氧化应激反应,改善凝血功能,而且不增加溶栓治疗后并发症。Objective To investigate the effect of different doses of urokinase on the thrombolytic effect and coagulation function of arteriovenous fistula thrombosis in maintenance hemodialysis(MHD)patients.Method The clinical data of 72 MHD patients with arteriovenous fistula thrombosis admitted to the People's Hospital of Jianyang from June 2017 to June 2021 were collected.According to the different doses of urokinase,the patients were divided into observation group(n=40,treated with 500000 U of urokinase)and control group(n=32,treated with 250000 U of urokinase).The thrombolysis-related conditions(48-hour success rate of thrombolysis,thrombolysis time),coagulation function indexes[activated partial thromboplastin time(APTT),thrombin time(TT),tissue-type plasminogen activator(tPA),plasminogen activator inhibitor(PAI),fibrin degradation product(FDP),D-dimer(D-D)levels],oxidative stress[nitric oxide(NO),catalase(CAT),superoxide dismutase(SOD)levels]and complications after thrombolytic were compared between the two groups.Result The 48-hour success rate of thrombolysis in the observation group was higher than that in the control group,the thrombolysis time was shorter than that in the control group,and the differences were statistically significant(P<0.05).Twenty-four hours and 7 days after thrombolysis,the levels of tPA and FDP in the two groups were higher,APTT and TT were longer,and the levels of PAI and D-D were lower than themselves before thrombolysis.And the levels of tPA and FDP in the observation group were higher,APTT and TT were longer,and the levels of PAI and D-D were lower than those in the control group,and the differences were statistically significant(P<0.05).Seven days after thrombolytic therapy,the levels of NO,SOD,and CAT in the observation group were significantly higher than those in the control group,and the differences were statistically significant(P<0.01).Conclusion Varying doses of urokinase in treating arteriovenous fistula thrombosis in patients with MHD could achieve reliable good therapeutic e

关 键 词：尿激酶 维持性血液透析 动静脉内瘘 溶栓效果 凝血功能 

分 类 号：R543[医药卫生—心血管疾病]