预防性尿激酶缓慢泵入时间对动静脉内瘘血流量的临床观察

Effects of slow infusion time of preventive urokinase on blood flow of arteriovenous fistula

目的通过预防性尿激酶缓慢泵入,防治血液透析患者动静脉内瘘血栓形成,观察泵入时间不同对动静脉内瘘血流量变化的影响,探讨预防性尿激酶缓慢泵入时间对动静脉内瘘血流量的影响。方法选择2015年8月至2016年12月诊治的长期血液透析患者96例,应用随机排列表法分为观察组和对照组1、对照组2,每组32例。对照组1每周泵入时间为1 h,对照组2每周泵入时间为3 h,观察组每周泵入时间为2 h,测定并比较3组患者治疗1个月及3个月后动静脉内瘘血流量的改变、副损伤发生率及各项实验室指标水平。结果观察组患者治疗1个月及3个月后,其动静脉内瘘的血流量分别为(910.2±66.5)ml/min、(916.3±65.6)ml/min,明显高于对照组1的(811.0±44.3)ml/min、(818.6±48.6)ml/min,差异有统计学意义(P<0.05);与对照组2的(903.0±65.7)ml/min、(915.9±47.1)ml/min,差异无统计学意义(P<0.05);治疗3个月后,观察组的副损伤发生率为0(0/32),对照组1也为0(0/32),差异无统计学意义(P<0.00),但对照组2为9.30%(4/32),与观察组比较有统计学差异(P<0.05);治疗前3组患者D-D、FDP、tPA、PAI水平比较并无明显差异(P>0.05);治疗1个月后3组患者tPA、PAI水平比较仍无明显差异(P>0.05),但观察组、对照组2的D-D、FDP水平明显高于对照组1,差异有统计学意义(P<0.05)。结论预防性缓慢泵入尿激酶能有效改善自体动静脉内瘘血流量,泵入时间合理对提高内瘘血流量有明显影响,且可有效改善纤溶凝血指标,增加泵入时间有可能发生不良反应,在动静脉内瘘治疗维护中需要正确选择。

Objective To prevent thrombosis of arteriovenous fistula in hemodialysis patients by slow infusion of preventive urokinase, and to observe the effects of different infusion time on blood flow of arteriovenous fistula, and to explore the effects of slow infusion time of preventive urokinase on blood flow of arteriovenous fistula.Methods Ninety-six patients with long-term hemodialysis who were treated in our hospital from August 2015 to December 2016 were randomly divided into observation group(n=32) and control group 1(n=32) and control group 2(n=32).The pumping time was 1 hour per week in control group 1,which was 3 hours per week in control group 2,which was 2 hours per week in observation group.The changes of blood flow of arteriovenous fistula at 1 m and 3 m after treatment,and incidence rate of secondary injury, and various laboratory indexes were observed and compared among the three groups.Results At 1 m and 3 m after treatment, the blood flow of arteriovenous fistula in observation group was(910.2±66.5)ml/min and(916.3±65.6)ml/min, respectively, which was significantly higher than that in control group 1( 811.0±44.3)ml/min,(818.6±48.6) ml/min,respectively(P<0.05),however, there was no significant difference between observation group and control group 2(903.0±65.7)ml/min,(915.9±47.1)ml/min,respectively(P>0.05).After 3-month treatment, the incidence rate of secondary injury in observation group was 0(0/32), and the control group 1 was also 0(0/32), there was no significant difference between the two groups(P>0.05),however, which in control group 2 was 9.30(4/32), there was no significant difference between observation group and control group 2(P<0.05).Before treatment there were no significant differences in the levels of D-D,FDP,tPA,PAI among the three groups(P>0.05). After 1-month treatment there were no significant differences in the levels of tPA and PAI among the three groups(P>0.05), but the levels of DD and FDP in observation group and control group 2 were significantly higher than those in control group 1(P<0.05).Conclusion Prophylactic slow pumping of urokinase can effectively improve the blood flow in autologous arteriovenous and insufflation. The reasonable pumping time can improve the blood flow of the internal hemorrhage, and can effectively improve the fibrinolytic coagulation indexes,moreover, the increase of the pumping time may results in incidence od adverse reactions.