尿激酶溶栓联合球囊扩张术治疗动静脉内瘘血栓闭塞的临床效果及相关因素分析

Clinical effect and related factors of urokinase thrombolysis combined with balloon dilatation for the treatment of arteriovenous fistula occlusion due to thromboembolism

目的分析尿激酶溶栓联合球囊扩张术治疗动静脉内瘘血栓闭塞的临床效果及相关影响因素。方法回顾性分析南昌市第一医院收治的动静脉内瘘血栓闭塞患者,观察手术成功率、并发症发生率,统计是否患糖尿病、内瘘使用时间、血栓闭塞段长度、血栓闭塞时间、血红蛋白水平及内瘘解剖因素对手术成功率的影响。结果共纳入84例患者,成功开通69例,手术成功率为82.1%。总体并发症发生率为7.1%,无严重并发症。单因素分析显示手术成功率在性别(χ^(2)=0.202,P=0.653)、糖尿病(χ^(2)=0.387,P=0.534)、内瘘位置(χ^(2)=0.082,P=0.774)、内瘘建立时间(χ^(2)=2.889,P=0.089)、血栓闭塞长度(χ^(2)=1.445,P=0.229)、内瘘闭塞时间(χ^(2)=0.082,P=0.774)、血红蛋白(χ^(2)=0.365,P=0.546)等方面均无统计学差异,与内瘘解剖因素密切相关(χ^(2)=29.238,P<0.001)。其中有2条静脉流出道(χ^(2)=18.287,P<0.001)或3条静脉流出道(χ^(2)=24.199,P<0.001)相对于有1条静脉流出道者手术成功率有显著差异,但前二者之间无显著差异(χ^(2)=0.002,P=0.967);多因素分析显示内瘘静脉流出道的数量是影响手术成功率的独立危险因素(OR=8.296,95%CI:2.724~25.267,P<0.001),内瘘建立时间是影响手术成功的保护因素(OR=0.976,95%CI:0.959~0.993,P=0.006)。结论尿激酶溶栓联合球囊扩张术治疗动静脉内瘘血栓闭塞安全有效。内瘘静脉流出道数量是影响手术成功率的危险因素,内瘘建立时间是影响手术成功率的保护因素,而性别、糖尿病、内瘘的位置、血栓闭塞长度、闭塞时间、血红蛋白水平均不影响手术成功率。

Objective To analyze the clinical effect and related influencing factors of urokinase thrombolysis combined with balloon dilation for the treatment of arteriovenous fistula(AVF)occlusion due to thromboembolism.Method The patients with AVF occlusion due to thromboembolism treated in The First Hospital of Nanchang City were retrospectively analyzed.The success rate of the operation and the incidence of complications were collected.Factors that possibly influence the success rate including diabetes,utilized period of the AVF,length of the occlusion in AVF,occlusion time,hemoglobin level and anatomical factors of the AVF were statistically analyzed.Results A total of 84 cases were enrolled in this study,of which 69 cases had successful patency of the AVF after the operation with the total success rate of 82.1%.The overall complication rate was 7.1%,and no serious complications occurred.Univariate analysis showed that the success rate of the operation was not related to gender(χ^(2)=0.202,P=0.653),diabetes(χ^(2)=0.387,P=0.534),location of AVF(χ^(2)=0.082,P=0.774),establishment time(χ^(2)=2.889,P=0.089),length of thrombus(χ^(2)=1.445,P=0.229),occlusion period(χ^(2)=0.082,P=0.774)and hemoglobin level(χ^(2)=0.365,P=0.546),but closely related to anatomical factors of the AVF(χ^(2)=29.238,P<0.001).The success rate of the operation was significantly different between the patients with 2 venous outflows(χ^(2)=18.287,P<0.001)or 3 venous outflows(χ^(2)=24.199,P<0.001)and those with one venous outflow,but had no difference between the patients with 2 or 3 venous outflows(χ^(2)=0.002,P=0.967).Multivariate analysis showed that the number of venous outflow of the AVF was an independent risk factor affecting the success rate of the operation(OR=8.296,95%CI:2.724~25.267,P<0.001),and the establishment time of fistula was a protective factor affecting the success rate of the operation(OR=0.976,95%CI:0.959~0.993,P=0.006).Conclusions Urokinase thrombolysis combined with balloon dilation is safe and effective for the treatment of thromboembolism in occluded AVF.The number of venous outflow of the AVF is an independent risk factor,and the establishment time of fistula is a protective factor to affect the success rate of the operation;gender,diabetes,the location of fistula,the length of thrombus,the occlusion period,and the hemoglobin level have no influences on the success rate of the operation.