尿激酶溶栓治疗血液透析患者动静脉内瘘血栓形成

Thrombolytic effects of urokinase in the treatment of thrombosed hemodialysis autologous arteriovenous fistulae

目的 观察尿激酶溶栓对血液透析患者动静脉内瘘血栓形成的疗效及影响因素。方法 注射尿激酶 5～ 5 0万u平均 (2 1.6± 13.1)万u对动静脉内瘘血栓行局部溶栓。治疗前后均行血管彩色超声检查 ,测定肝肾功能、凝血酶原时间 (PT)及血浆纤维蛋白原 (Fib) ,并监测血压 ,观察不良反应发生情况。结果 48例患者共行 5 0次溶栓治疗 ,成功 43例次 (86 %) ,瘘管在注射尿激酶 (47.3± 6 2 .8)min后通畅。在治疗成功例次中男性和绝经期女性比例显著高于未成功例次 ,在血栓形成时间上治疗成功例次显著短于治疗未成功者 ,治疗未成功例次中血栓形成时间在 48小时以上者及病因为血栓性静脉炎者比例均分别显著高于治疗成功例次。治疗后患者肝肾功能、PT、Fib及血压与治疗前比较无显著差异。无 1例患者发生出血及栓塞并发症 ,3例患者用药后出现一过性发热。结论 尿激酶溶解透析通路血栓操作简单 ,创伤小 ,成功率较高 ,不良反应少 ,有较高的临床应用价值。但对于女性患者、血栓较为陈旧及存在血栓性静脉炎等情况疗效可能不理想。

Objective To observe the thrombolytic effects of urokinase in the treatment of thrombosed hemodialysis autologous arteriovenous fistulae and to analyze the factors influencing the effects. Methods Urokinase was injected into the thrombosed fistulae with the dose of 50000～500000u. Before and after treatment, the color Doppler ultrasonography was performed to examine the fistulae. The hepatic and renal function, prothrombin time and the plasma fibrinogen were detected, and the blood pressure was measured. The side effects were also observed. Results Of the total 50 treatment, 43(86%) were successful. In the successful cases, the proportion of male and climacteric female patients was higher than that in the unsuccessful cases. The thrombosis time of the successful cases was shorter. And the proportion of the patients who were suffered from thrombophlebitis was higher in the unsuccessful cases. No bleeding and embolism complication were observed. Conclusion The thrombolytic treatment using urokinase is an effective method in thrombosed hemodialysis autologous arteriovenous fistulae. But the effect may unsatisfactory in female and patients whose thrombosis time was longer or who were suffered from thrombophlebitis.