尿激酶治疗动静脉内瘘急性血栓有效与无效的患者临床特征比较

Association between effectiveness of urokinase therapy and clinical characteristics in patients with acute thrombosis of arteriovenous fistula

目的比较尿激酶治疗动静脉内瘘急性血栓有效与无效的患者临床特征,以探讨可能影响尿激酶溶栓效果的相关因素。方法选取2017年1月至2019年12月杭州市中医院肾内科收治的,采用超声引导下尿激酶治疗动静脉内瘘急性血栓患者82例,其中自体动静脉内瘘(AVF)患者51例、移植物动静脉内瘘(AVG)患者31例。将溶栓治疗有效的45例患者作为有效组,无效的37例患者作为无效组,观察并比较两组患者血栓栓塞时间、溶栓治疗并发症(出血、血肿)发生率及溶栓治疗前动静脉内瘘基本情况。结果与无效组比较,有效组患者血栓栓塞时间较短(P<0.05)。两组患者出血、血肿等溶栓治疗并发症发生率比较差异均无统计学意义(均P>0.05)。在AVF患者中,与无效组比较,有效组患者吻合口内径、桡动脉内径、头静脉内径较长,吻合口流速更快、血栓长度较短,瘤样扩张发生率较低,差异均有统计学意义(均P<0.05)。在AVG患者中,与无效组比较,有效组患者动脉吻合口内径较大、血流速较快(均P<0.05)。结论临床对于动静脉内瘘急性血栓患者,不能盲目进行尿激酶溶栓治疗,以免增加内瘘血管二次损伤、消耗有限的血管资源。内瘘血栓栓塞时间、吻合口内径、桡动脉内径、血栓长度、吻合口血流速和瘤样扩张等可作为是否进行尿激酶溶栓治疗的参考指标,以提高溶栓治疗的有效率。

Objective To investigate the association between the effectiveness of urokinase therapy and clinical characteristics in patients with acute thrombosis of arteriovenous fistula.Methods Eighty two patients with acute thrombosis of arteriovenous fistula were treated with ultrasound-guided urokinase in Hangzhou Hospital of Traditional Chinese Medicine from January 2017 to December 2019,including 51 cases of autogenous arteriovenous fistulas(AVF)patients and 31 cases of ateriovenous graft(AVG).Among them,45 patients were effective in thrombolytic therapy(effective group)and 37 patients were ineffective in thrombolytic therapy(ineffective group).The thromboembolismtime,the incidence of thrombolytic therapy complications(bleeding,hematoma)and the basic situation of arteriovenous fistula were compared between two.Results Compared with the ineffective group,the thromboembolismtime of patients in the effective group was shorter(P<0.05).There was no significant difference in the incidence of hemorrhage,hematoma and other complications of thrombolytic therapy between the two groups(all P>0.05).In AVF patients,compared with the ineffective group,the effective group has longer anastomotic diameter,radial artery diameter,and cephalic vein diameter,faster anastomotic flow rate,shorter thrombus length,and lower incidence of tumor-like expansion(all P<0.05).In AVG patients,compared with the ineffective group,the effective group had larger arterial anastomotic diameter and faster blood flow rate(all P<0.05).Conclusion For patients with acute thrombosis of internal arteriovenous fistula,the thromboembolism time,anastomotic diameter,radial artery diameter,thrombus length,anastomotic blood flow rate,and tumor-like expansion can be used as reference indicators for urokinase thrombolytic therapy to improve the effective rate of thrombolytic therapy.