动静脉内瘘闭塞改良新型溶栓方式疗效的回顾性比较分析

Retrospective comparative analysis of the efficacy of modified new-type thrombolytic therapy for arteriovenous fistula occlusion

目的探讨利用血管鞘与普通留置针在超声引导下脉冲式移动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2015年3月～2018年3月间本中心收治的84例动静脉内瘘闭塞患者为A组,采用血管鞘超声引导下脉冲式移动式精准注射溶栓法治疗28例,B组采用留置针超声引导下脉冲式移动式精准注射溶栓法治疗56例,比较两种不同溶栓方式的溶栓成功率及溶栓后并发症。结果两组在患者平均年龄、内瘘平均使用寿命、血液透析治疗时间和血栓形成时间方面比较无显著性差异(P>0.05),A组比B组溶栓成功率大(P<0.05),两组在溶栓术后术肢穿刺点出血、血肿形成和局部疼痛等并发症上无明显差异(P>0.05),上述溶栓患者未出现肢体活动障碍,栓子脱落导致肺栓塞等严重并发症。结论利用血管鞘超声引导下脉冲式移动式精准注射溶栓法具有操作简单,容易上手,溶栓精准,血栓抽吸效果好,溶栓时间明显缩短,对患者血管损伤小,安全有效且内瘘溶栓成功几率极高,对长段血栓疗效亦显著,能有效确切地延长内瘘的使用寿命,有效保证透析疗效,应用价值大,因此目前精准医学的医疗大环境下,该技术值得在临床工作中推广应用。

Objective To investigate the efficacy of two different thrombolytic methods, namely the use of a vascular sheath and an indwelling needle under ultrasound-guided pulse-type mobile precision injection thrombolysis, in the treatment of arteriovenous fistula occlusion. Methods A retrospective analysis was performed on 84 cases of arteriovenous fistula occlusions who were admitted to our center from March, 2015 to March, 2018. Ultrasound-guided pulse-type mobile precision injection thrombolysis was used to treat 28 patients of group A by vascular sheath. Ultrasound-guided pulse-type mobile precision injection thrombolysis was used to treat 56 patients of group B by indwelling needle. The thrombolytic success rate and complications after thrombolysis were compared between two different thrombolysis methods. Results There were no significant differences between the two groups in the average age, mean service life of the internal fistula, the duration of hemodialysis treatment and the thrombosis time（P〉0.05）. The thrombolysis success rate was higher in the group A than in the group B（P〈0.05）. There was no significant difference in the complications such as bleeding hematoma formation due to bleeding of the puncture point of limb and local pain between the two groups after thrombolysis（P〉0.05）. The above thrombolysis patients did not have physical activity disorders, and serious complications such as pulmonary embolism due to embolus falling off. Conclusion The use of vascular sheath ultrasound-guided pulse-type mobile precision injection thrombolysis method has a simple operation, is easy to use, has precise thrombolysis, and has a good thrombus suction effect. The thrombolytic time is significantly shorter, which has less vascular injury to the patient, and is safe and effective and the successful rate of internal fistula thrombolysis is significantly high. Its effect on long-segmental thrombosis is also significant. It can effectively extend the service life of internal fistula, effectively guarantee the efficacy of dialysis, and has a great application value. Therefore, under the current medical environment of precision medicine, this technology is worthy of promotion and application in clinical work.