局部尿激酶溶栓治疗血透患者动-静脉内瘘血栓疗效与护理

Curative effect and nursing of local application of urokinase in the treatment of thrombosed arteriovenous fistulae of hemodialyzed patients

目的探讨局部尿激酶溶栓治疗血透患者动-静脉内瘘血栓形成的疗效、影响因素及护理要点。方法回顾分析28例44例次局部注射尿激酶治疗动-静脉内瘘血栓形成患者的资料，观察疗效、影响因素及护理资料。结果28例共44例次溶栓，32例次溶通占72．7％。溶栓成功率与血栓形成时间及有无附壁血栓形成明显相关。溶通组有53．13％患者发生再栓塞，再栓塞的发生率与有无附壁血栓及原发病有关，糖尿病患者再栓塞的发生率高。尿激酶量≤60万U溶通例数达81．3％，栓塞≤36h溶通例数达96．9％。常见的副作用为皮下血肿、鼻衄及牙龈出血。注意溶栓时穿刺进针部位及方向对溶栓效果及减少副作用十分必要。结论局部尿激酶溶栓治疗内瘘血栓形成操作简单，溶通率高达72．7％，有较高的临床应用价值。溶栓效果与血栓形成时间、有无附壁血栓及原发病有关。溶栓用尿激酶剂量以不超过60万U为佳，溶栓时机应选择在内瘘栓塞24h以内，最多不超过36h。溶通后尿激酶及低分子肝素维持治疗可预防溶通后再发栓塞。注意溶栓时穿刺进针部位及方向对溶栓效果及减少副作用。溶栓期间建议采用临时血管通路减少内瘘损伤。

Objective To study the curative effect, influential factors and nursing points of local application of urokinase in the treatment of thrombosed arteriovenous fistulae of hemodialyzed patients. Methods The information of 28 hemodialyzed patients with thrombosed arteriovenous fistulae, who were injected the close of KU urokinase for 44 times, were retrospectively analyzed. Then the curative effects, influential factors and nursing information were observed. Results Of 44 times of thromblytic treatments in 28 cases, 32 times （72.7 % ） were successful. The successful rate of thrombolysis was obviously related to the thrombus formation time and that whether or not the formation of mural tl^rombus takes place. 53.13% of the successful cases had thrombosis again. The rate of reappearanced rethrombosis was related to that whether or not the formation of mural thrombus takes place and the protopathy. The incidence rate of thrombosis was higher in diabetic patients. 81.3% of the very successful cases used the dose of urokinase ≤ 60KU. And the time of thrombosis was less than 36h in 96. 9% successful cases. The common side effects of urokinase were subcutaneous hemorrhage, epistaxis and gingiva bleeding. It should be noted that the site and the direction of puncture when the thrombolysis occurs were very essential to the effects of thrombolysis and the reduction of side reactions. Conclusions The thrombolytic treatment using urokinase is an effective method in thrombosed hemodialysis autoIogous arteriovenous fistulae. The throughtout rate of thrombolysis is up to 72.7% , having a great value in clnical application. The effects of thrombolytic are related to the thrombus formation time, whether or not the formation of mural thrombus takes place and the protopathy. The dose of urokinase is not more than 60KU. The thrombolytic treatment is within 24h after thrombosis, and not more than 36h at maximum. Using urokinase and low molecular heparin can prevent thrombus reappearanced. It should be noted the site and the direction of puncture when the thrombolysis occurs and the reduction of side reactions. It is suggested that the temporary vessel pathway is used to reduce the injury of fistula during the period of thrombolysis.