动静脉内瘘闭塞两种不同溶栓方式疗效的回顾性比较分析

A retrospective comparative analysis of the efficacy of two different thrombolytic methods in the treatment of arteriovenous fistula occlusion

目的探讨传统溶栓与超声引导下移动式脉冲式精准注射溶栓两种不同溶栓方式在动静脉内瘘闭塞治疗中的疗效。方法回顾性分析本中心2011年12月~2016年12月之间收治的82例动静脉内瘘闭塞患者,其中采用超声引导下移动式脉冲式精准注射溶栓法治疗41例,采用传统溶栓方法治疗41例,比较两种不同溶栓方式的溶栓成功率及溶栓后并发症。结果两组的年龄、透析龄、内瘘使用年限及血栓形成时间对比无显著性差异(P>0.05),超声引导下移动式脉冲式精准注射组溶栓成功率显著高于传统组(P<0.05),在出血、血肿形成、局部疼痛等并发症上明显少于传统组,差异具有统计学意义(P<0.05),两组均未出现栓子脱落、肺栓塞、肢体活动障碍等严重并发症。结论超声引导下移动式脉冲式精准注射溶栓法具有操作简单,容易上手,对患者血管损伤小,并发症少,安全有效且内瘘溶栓成功几率极高,费用相对较小,能有效延长维持性血液透析患者的生命线,大大减少患者的痛苦,目前精准医学大环境下,这一改良的超声引导下移动式脉冲式精准注射尿激酶溶栓技术值得推广应用。

Objective To explore the effect of two different thrombolytic methods including traditional thrombolysis and ultrasound guided mobile pulse thrombolytie injection in the treatment of arteriovenous fistula occlusion. Methods A total of 82 patients with arteriovenous fistula occlusion in our center from December 2011 to December 2016 were retrospectively analyzed. Among them, 41 cases were treated by ultrasound-guided mobile pulsed precision thrombolysis and 41 cases were treated with traditional thrombolysis.The thrombolytic success rate and postthrombolytic complications of two different thrombolytic methods were compared. Results There was no significant difference in age, dialysis age, age of fistula and thrombosis time between the two groups （P〉0.05）. The success rate of thrombolysis in the ultra- sound-guided pulsed precision thrombolysis group was significantly higher than that in traditional group （P〈0.05）. The incidences of hemorrhage, hematoma formation and local pain in the ultrasound-guided pulsed precision thrombolysis group were significantly lower than those of the traditional group, and the difference was significant （P〈0.05）. There were no serious complications such as embolization, pulmonary embolism and physical activity disorder in both groups. Conclusion Ultrasound-guided mobile pulsed precision thrombolysis has the advantages of simple operation, easy oper- ation, few vascular damage and few complications,which is safe and effective.The probability of successful fistula throm- bolysis is relatively high and the cost is relatively small and effective.And the method can extend the lifeline of mainte- nance hemodialysis patients effectively,and greatly reduce the pain of patients, with great value.So this improved uhra- sound-guided mobile pulse urokinase thrombolytic injection is worthy of popularization and application in the current precise medical environment.