PTA结合药物溶栓对动静脉内瘘血栓患者术后疗效及内瘘通畅率的影响

Effect of PTA Combined with Drug Thrombolysis on Postoperative Efficacy and Fistula Patency Rate in Patients with Arteriovenous Fistula Thrombus

目的:评估经皮腔内血管成形术(percutaneous transluminal angioplasty,PTA)结合尿激酶溶栓治疗对动静脉内瘘血栓患者术后疗效及内瘘通畅率的影响。方法:选择2020年1月—2022年7月连云港市第一人民医院肾内科收治的90例动静脉内瘘血栓患者,采用随机数字表法分为对照组和观察组,各45例。对照组接受PTA治疗,观察组接受尿激酶溶栓+PTA治疗。对比两组手术时间、手术成功率、肱动脉平均血流量、内瘘通畅率、凝血功能指标(活化部分凝血活酶时间、凝血酶时间、D-二聚体)、肌酐和血尿素氮水平及不良反应发生率。结果:两组手术成功率、术后肱动脉平均血流量比较,差异均无统计学意义(P>0.05)。术后,观察组内瘘通畅率高于对照组(P<0.05);观察组凝血功能、肌酐和血尿素氮水平均优于对照组,差异均有统计学意义(P<0.05)。两组并发症发生率比较,差异无统计学意义(P>0.05)。结论:尿激酶溶栓结合PTA治疗能够有效改善动静脉内瘘血栓患者的内瘘通畅率和凝血功能。

Objective:To evaluate the effect of percutaneous transluminal angioplasty(PTA)combined with urokinase thrombolysis on the postoperative efficacy and fistula patency rate of arteriovenous fistula thrombus in patients.Method:A total of ninety patients with arteriovenous fistula thrombus admitted to the Department of Nephrology of the First People's Hospital of Lianyungang from January 2020 to July 2022 were selected,they were divided into a control group and an observation group by random number table method,with 45 cases each group.The control group received PTA treatment,while the observation group received urokinase thrombolysis combined with PTA treatment.The surgery time,surgery success rate,brachial artery average blood flow,fistula patency rate,coagulation function indicators(activated partial thromboplastin time,thrombin time,D-dimer),creatinine and blood urea nitrogen levels,and incidence of adverse reactions were compared between the two groups.Result:The surgery success rate and the postoperative average blood flow in the brachial artery in both groups were compared,the differences were not statistically significant(P>0.05).The postoperative fistula patency rate of the observation group was higher than that of the control group(P<0.05);the coagulation function,creatinine,and blood urea nitrogen levels in the observation group were better than those in the control group,the differences were statistically significant(P<0.05).There was no significant difference in the incidence of complications between the two groups(P>0.05).Conclusion:Urokinase thrombolysis combined with PTA treatment can effectively improve the fistula patency rate and coagulation function in patients with arteriovenous fistula thrombus.