尿激酶溶栓治疗内瘘血栓形成

High dose of urokinase therapy for thrombosed arteriovenous fistulas

目的 探讨外周和经皮穿刺股动脉导管注入尿激酶对动静脉内瘘血栓形成的治疗效果。 方法 对 16内瘘血栓形成的病人分别进行了外周溶栓和股动脉插管溶栓治疗。方法是 12例病人于内瘘的动脉端穿刺后输注尿激酶 ,4例病人在DSA下经动脉插管至血栓部位 ,灌注尿激酶 ,尿激酶用量为 75～ 10 0万 U,外周溶栓输注时间为 3～ 4 h,导管溶栓时间为 4 5～6 0 m in。 结果 12例外周溶栓病人再通 6例 ,外周溶栓成功率为 5 0 % ,6例失败 ,其中 4例进行了插管溶栓 ,3例成功 ,1例失败 ,成功率为 75 % ,再通后的内瘘次日可行血液透析 ,并随访了 6～ 4 4月 ,情况良好。 结论 尿激酶局部输注治疗内瘘血栓形成是安全有效的 ,可以作为首选的治疗措施。

Objective To study the effect of urokinase on thromboses of the arteriovenous fistulas by infusion and intraarterial infusion. Methods 12 patients with thromboses of the angioaccess were infused via a small needle into the feeding artery by urokinase, 4 patients were performed intraarterial infusion into the thrombus by urokinase at DSA unit. The dosage of urokinase was 750 000 ～ 1 000 000 IU , and the infusion time was average 3~4 hour. Results A complete thrombolysis with return of bruit and thrill was obtained in 50% patients by infusion and 75% patients by intraarterial infusion. In follow up 6～44 months,there are good patency in all the successful case after thrombolysis except of one case reclotted. Conclusion In summary, urokinase local infusion provides a useful means of preservation on AVF and may be used as the therapy of first choice in dialysis patients.