尿激酶联合低分子肝素、华法林对维持性血液透析患者动静脉内瘘血栓形成及凝血功能的影响

Effects of urokinase combined with low molecular weight heparin and warfarin on arteriovenous ?stula thrombosis and coagulation function in patients with maintenance hemodialysis

目的探讨尿激酶联合低分子肝素、华法林在维持性血液透析(maintenance hemodialysis,MHD)患者动静脉内瘘(arteriovenous fistula,AVF)血栓中的应用及对凝血功能的影响。方法回顾性分析2016年3月-2018年3月安康市中心医院收治MHD患者84例,根据患者治疗方案不同分为观察组与对照组,各42例,对照组给予单纯尿激酶溶栓,观察组在尿激酶溶栓下,联合使用低分子肝素及华法林,持续治疗6 d后,比较2组溶栓情况(72 h溶栓成功率、溶栓所用时间、尿激酶用量)、凝血功能[活化部分凝血活酶时间(activated partial thromboplastin time,APPT)、凝血酶原时间(prothrombin time,PT)、纤维蛋白原(fibrinogen,FIB)、D-二聚体(D-dimer,D-D)水平]、氧化应激水平[超氧化物歧化酶(superoxide dismutase,SOD)、Ras相关C3肉毒素酶解-2(ras-relatedC3botulinumtoxinsubsteate,Rac-2)、血红素氧化酶-1(heme oxygenase-1,HO-1)水平]、并发症及3个月内再栓塞发生情况。结果观察组72h溶栓成功率显著高于对照组(P<0.05),观察组溶栓所用时间、尿激酶用量均显著低于对照组(P<0.05);2组治疗后,APPT、PT、D-D均显著低于治疗前(P<0.05),且观察组各指标降低幅度大于对照组(P<0.05);2组治疗后FIB水平均显著低于治疗前(P<0.05),但组间比较差异无统计学意义(P>0.05);2组SOD、Rac-2、HO-1水平均显著低于治疗前(P<0.05),且观察组各指标下降程度大于对照组(P<0.05);观察组并发症总发生率低于对照组,但差异无统计学意义(P>0.05);观察组3个月内再栓塞发生率显著低于对照组(P<0.05)。结论尿激酶联合低分子肝素、华法林用于MHD患者AVF血栓形成治疗中,溶栓效果更好,能改善患者凝血功能,降低再栓塞发生率。

Objective To explore the applicability of urokinase combined with low molecular weight heparin and warfarin in the treatment of arteriovenous fistula(AVF)thrombosis of patients with maintenance hemodialysis(MHD)and its effects on coagulation function. Methods The clinical data on 84 patients with MHD admitted to our hospital between March 2016 and March 2018 was ret rospectively analyzed. These patients were divided into the obser vation group and control group with 42 cases in each according to treatment regimens. The control group was given urokinase thrombolysis alone, while the obser vation group was additionally given low molecular weight hepar in combined with warfarin. The treat ment lasted six days. The effect of th rombolysis, coag ulation function, prothrombin time(PT), fibrinogen(FIB), D-dimer(D-D), oxidative stress levels, complications and reembolism within 3 months were compared between the two groups. Results The 72 h thrombolysis success rate in the obser vation g roup was sig nif icantly higher than that in the cont rol g roup(P<0.05), while the time taken by thrombolysis and urokinase dose in the obser vation g roup were sig nif icantly shor ter or lower(P<0.05). The levels of APPT, PT and DD in the two groups after treatment became signi cantly lower(P<0.05), especially in the obser vation group(P<0.05). The FIB level decreased signi cantly after treatment(P<0.05), but there was no signi cant difference between the two groups(P>0.05). The levels of SOD, Rac-2 and HO-1 in the two groups were sig nif icantly lower after treat ment(P<0.05), especially in the obser vation g roup(P<0.05). The total incidence of complications in the observation group was lower than that in the control group(P>0.05). The incidence of reembolism in the observation group within 3 months was signif icant lower than that in the control group(P<0.05). Conclusion Urokinase combined with low molecular weight heparin and warfarin for AVF th rombosis in MHD patients is effective for thrombolysis, and can improve coagulation function while reducing the incidence of reembolism.