局部尿激酶溶栓治疗血液透析患者动静脉内瘘血栓疗效及治疗方案探讨.docxVIP

局部尿激酶溶栓治疗血液透析患者动静脉 内痿血栓疗效及治疗方案探讨 2007 年 11月第6 卷第 11 期 Chinese — JournalofBlo 2007 年 11月第 局部尿激酶溶栓治疗血液透析患者动静脉内痿血栓疗效及 治疗方案探讨 宋岩李冀军张壹言李学义陈风琨赵长征姚风华殷培 【摘要】目的探讨局部尿激酶溶栓治疗血液透析患者动静脉内痿血栓形成的疗效, 影响因素 及溶栓方案?方法回顾分析解放军总医院第一附属医院28例局部注射丿求激酶治疗 动静脉内痿血栓 形成患者的资料，观察疗效，影响因素及预后?结果28例共44例次溶栓,32例次溶 通(72.7%). 溶通组血栓形成时间明显短于溶栓失败组，溶栓失败组附壁血栓形成发生率较溶 通组高.溶通组有 53.13%患者发生再栓塞，再栓塞的发生率与有无附壁血栓及原发病有关，糖尿病患 者再栓塞的发生率 高?尿激 高?尿激 量W60万Iu溶通率达81.3%,栓塞W36h溶通率达96.9%,2例溶通后 16?48h再次栓塞， 予尿激酶静脉滴注后再次溶通?常见的副作用为皮下血肿，鼻1?及牙龈出血?结论 局部尿激酶溶栓 治疗内痿血栓形成操作简单，溶通率高达72.7%,有较高的临床应用价值.溶栓效果 与血栓形成时间， 有无附壁血栓及原发病有关?溶栓用尿激酶剂量以不超过60万Iu为佳，溶栓时机 应选择在内痿栓塞 24h以内，最多不超过36h.溶通后尿激酶及低分子肝素维持治疗可预防溶通后再 发栓塞. 【关键词】尿激酶;动静脉内痿;溶栓;血栓形成 中图分类号:R973.2R318.16文献标识码:A Therapeuticeffectandregimenofthrombolysisbylocaluseofurokinaseforthetreatmentofth rom? bos.sinarteriovenousfistulainhemodialysispatientsSONGYan,LIYi-jun,ZHANG Yi-yan 丄 IXue-yi， CHENFeng — kun.zHAoChang — zheng,YAOFeng — hua.YIPe.DepartmentofNephrology.TheFirstAffiliated Hospital,GeneralHospitalofPL4,Beifing 10003China [Abstract]ObjectiveTostudytheeffect,therapeuticcourseandrelatedfactorsoflocalurokin ase applicationforthetreatmentofthrombosisinarteriovenousfistulainhemodialysispatients. MethodsLocal inrectionofurokinasewasusedin28hemodialysispatientsforthetreatmentofthrombosisinf istula.Colored Dopplerultrasonography,hepaticandrenalfunctions,pmthrombintimeandplasmafibrinog enweremeasured beforeandafterthetreatment.ResultsThethrombolytictreatmentwasusedforthe28casesin atomlof44 times.ofwhich32times(72.7%lshowedsuccessfulresults.Theproportionofmaleandclima ctericfemale patientswashigherinthesuccessfulcasesthanintheunsuccessfulpatients.Sh o ?erthrombosi stimeandless muralthrombosiswerefoundinthesuccessfulcases.However.thrombosisrecurredin5 3」3 %ofthesuccessful patients.Recurrenceofthrombosiswasrelatedtomuralthrombosisandtheircomplicateddis eases,andwas frequentlyseenindiabeticpatients.Whenurokinasewasusedinadoseoflessthan60.0001U.s uccessful resultswerefoundin81.3%cases,andin96.9%caseswhoseblockedfistulala