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

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1、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—odPurification,November12,2007,Vo1.6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

2、%).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

3、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:ATherapeuticeffectandregimenofthrombolysisbylocaluseofurokinaseforthetreatmentofthrom・bos.sinarteriovenousfistulainhemodialysispatientsSONGYan,LIYi-jun,ZHANGYi-yan丄IXue-yi，CHENFeng—kun.zHAoChang—zhen

4、g,YAOFeng—hua.YIPe.DepartmentofNephrology.TheFirstAffiliatedHospital,GeneralHospitalofPL4,Beifing10003China[Abstract]ObjectiveTostudytheeffect,therapeuticcourseandrelatedfactorsoflocalurokinaseapplicationforthetreatmentofthrombosisinarteriovenousfistulainhemodialysispatients.MethodsLo

5、calinrectionofurokinasewasusedin28hemodialysispatientsforthetreatmentofthrombosisinfistula.ColoredDopplerultrasonography,hepaticandrenalfunctions,pmthrombintimeandplasmafibrinogenweremeasuredbeforeandafterthetreatment.ResultsThethrombolytictreatmentwasusedforthe28casesinatomlof44times

6、.ofwhich32times(72.7%lshowedsuccessfulresults.Theproportionofmaleandclimactericfemalepatientswashigherinthesuccessfulcasesthanintheunsuccessfulpatients.Sho〜erthrombosistimeandlessmuralthrombosiswerefoundinthesuccessfulcases.However.thrombosisrecurredin53」3%ofthesuccessfulpatients.Recu

7、rrenceofthrombosiswasrelatedtomuralthrombosisandtheircomplicateddiseases,andwasfrequentlyseenindiabeticpatients.Whenurokinasewasusedinadoseoflessthan60.0001U.successfulresultswerefoundin81.3%cases,andin96.9%caseswhoseblockedfistulalastedlessthan36hours.In2cases.thrombosisrecurredafter

8、openi