低剂量尿激酶联合四步按摩法治疗自体动静脉内瘘血栓形成效果及作用机制  

Effect and mechanism of low dose urokinase combined with four-step massage in the treatment of autogenous arteriovenous fistula thrombosis

作　　者：张敬涛 霍鹏飞[1] 张晶晶 林慧芳 王娟[1] 郑建芳[1] 秦振书[1] ZHANG Jing-tao;HUO Peng-fei;ZHANG Jing-jing;LIN Hui-fang;WANG Juan;ZHENG Jian-fang;QIN Zhen-shu(Emergency Department of Xingtai Municipal People's Hospital,Xingtai 054000,China)

机构地区：[1]邢台市人民医院急诊科,邢台054000

出　　处：《北京中医药》2023年第2期162-167,共6页Beijing Journal of Traditional Chinese Medicine

基　　金：河北省中医药管理局科研计划项目(2019522)。

摘　　要：目的观察低剂量尿激酶联合四步按摩法治疗自体动静脉内瘘(AVF)血栓形成的效果,并探讨其作用机制。方法选取2020年3月—2021年5月邢台市人民医院收治的86例AVF血栓形成患者,采取随机数字表法将其分成观察组与对照组各43例。对照组予以高剂量尿激酶常规溶栓治疗,观察组采取低剂量尿激酶联合四步按摩法治疗,疗程均不超过3 d。观察2组溶栓效果,比较治疗前后2组活化部分凝血酶原时间(APTT)、凝血酶原时间(PT)、血浆纤维蛋白原(FIB)、D-二聚体(D-D)、血浆C反应蛋白(CRP)、可溶性内皮细胞蛋白C受体(s EPCR)、高迁移率族蛋白B1(HMGB1)水平。记录2组不良事件发生情况。结果与对照组相比,观察组内瘘再通率高,内瘘溶通时间短,瘘口处内径大,溶通后首次透析血流量多,差异均有统计学意义(P<0.05)。治疗后2组APTT、PT均较治疗前延长,血浆FIB、D-D、CRP、s EPCR和HMGB1水平均较治疗前降低,差异均有统计学意义(P<0.05);且观察组以上指标均比对照组变化更明显(P<0.05)。观察组不良事件发生率低于对照组(P<0.05)。2组均无血栓脱落、过敏反应、颅内出血、内脏出血等严重不良事件发生,其他安全性指标亦均未观察到异常。结论低剂量尿激酶联合四步按摩法治疗AVF血栓形成,溶栓效果优于高剂量尿激酶溶栓治疗,且减少尿激酶不良反应,其作用机制可能与改善凝血功能及下调CRP、s EPCR、HMGB1水平有关。Objective To observe the effect of low dose urokinase combined with four-step massage on autogenous arteriovenous fistula(AVF)thrombosis and explore its mechanism.Methods A total of 86 patients with AVF thrombosis admitted to Xingtai People’s Hospital from March 2020 to May 2021 were selected and divided into observation group and control group by random number table method with 43 cases in each group.The control group was given routine thrombolytic therapy with high-dose urokinase,while the observation group was given low-dose urokinase combined with four-step massage,and the treatment course of both groups was no more than 3 days.The thrombolytic effect of 2 groups was observed,the levels of coagulation function indexes[activated partial prothrombin time(APTT),prothrombin time(PT),plasma fibrinogen(FIB),D-dimer(D-D)],plasma C-reactive protein(CRP),soluble endothelial cell protein C receptor(s EPCR)and high mobility group protein B1(HMGB1)were compared between the two groups before and after treatment.Treatment related side effects were recorded in 2 groups.Result Compared with the control group,the observation group had higher internal fistula recirculation rate,shorter internal fistula lysis time,larger internal diameter at the orifice fistula,and higher initial dialysis blood flow after dissolution,with statistical significance(P<0.05).After treatment,APTT and PT in 2 groups were longer than that before treatment,and plasma FIB and D-D,CRP,s EPCR and HMGB1 levels were lower than that before treatment,with statistical significance(P<0.05).After treatment,the above indexes in the observation group changed more significantly than that in the control group(P<0.05).The incidence of adverse events in observation group was lower than that in control group(P<0.05).No serious adverse events such as thrombus loss,allergic reaction,intracranial hemorrhage and visceral hemorrhage occurred in the 2 groups,and no abnormalities were observed in other safety indicators.Conclusion The thrombolytic effect of low-dose urokina

关 键 词：自体动静脉内瘘 血栓形成 尿激酶 四步按摩法 凝血功能 炎症反应 

分 类 号：R692.5[医药卫生—泌尿科学]