自体动静脉内瘘血栓形成溶栓治疗应用不同穿刺方式的效果比较

A Comparison of the Effects of Two Different Puncturing Methods used in Thrombolytic Therapy Treating Autogenous Arteriovenous Fistula Thrombosis

目的探讨自体动静脉内瘘血栓形成患者采用不同穿刺方式给予尿激酶溶栓的效果。方法选择2013年1月—2016年12月动静脉内瘘血栓形成的血液透析患者40例,根据透析时内瘘穿刺方法和穿刺针的不同分为2组,使用扣眼法钝针穿刺者为A组,共20例;使用绳梯式或局域式穿刺者为B组,共20例,两组均使用尿激酶局部溶栓治疗。A组用16 G钝针在内瘘动脉端扣眼穿刺点穿刺,脉冲式或投弹式给药法;B组在血栓形成端用6号头皮针穿刺,将尿激酶药液从内瘘动脉端注入,用微量泵维持给药的方法溶栓。结果 2组尿激酶溶栓总溶通率为82.5%,使用钝针穿刺的A组溶通率为95.0%,绳梯式或局域式穿刺的B组溶通率为70.0%,组间比较有显著性差异,同时B组的皮下瘀血、疼痛等副作用明显高于A组。结论尿激酶脉冲式给药治疗内瘘血栓简便有效,并发症少,使用钝针穿刺者溶栓效果优于绳梯式或局域式穿刺者。

Objective To explore and compare the therapeutic effects of two different puncturing methods used in thrombolytic therapy with urokinase in autogenous arteriovenous fistula（AVF） in hemodialysis（HD） patients. Methods Da- ta were collected from January 2013 to December 2016, 40 HD patients with AVF thrombosis, were divided into two groups based on different puncturing methods and puncture needles. In group A of twenty patients, buttonhole puncturing was done using blunt needle ; in group B of 20 patients, ladder or local puncturing was done. Both groups were treated with local throm- bolytic therapy using urokinase. In group A, 16G blunt needles were used to puncture the buttonhole at the artery end of in- ternal fistula, and drugs were administered in a pulse - spray or targeted way. In group B, No. 6 scalp needles were used for puncturing at the thrombosis end, and urokinase was injected from the artery end of internal fistula. A micro - pump was used for drug administration. Results Total patency rate of the AVF in the two groups was 82.5 %, with a patency rate of 95.0% in group A and 70.0% in group B, respectively. The results of the two groups were significantly different. The complications such as ecchymoma and related pain in group B were more common than in group A. Conclusion In the treatment of AVF thrombosis, urokinase administered in the pulse - spray way wis more convenient and effective, and leads to less complica- tions. The puncturing with blunt needles is better in thrombolytic effects than ladder or local puncturing.