中国基层医药
中國基層醫藥
중국기층의약
CHINESE JOURNAL OF PRIMARY MEDICINE AND PHARMACY
2015年
17期
2667-2669
,共3页
血液透析滤过%动静脉瘘%血栓溶解疗法%尿激酶%内瘘栓塞
血液透析濾過%動靜脈瘺%血栓溶解療法%尿激酶%內瘺栓塞
혈액투석려과%동정맥루%혈전용해요법%뇨격매%내루전새
Hemodiafiltration%Arteriovenous fistula%Thrombolytic therapy%Urokinase%Low molecular heparin
目的：分析常规尿激酶溶栓联合局部导丝碎栓和低分子肝素抗凝治疗血液透析患者动静脉内瘘栓塞的疗效，探讨其应用前景。方法30例血液透析动静脉内瘘栓塞患者，根据自愿原则分为碎栓组15例和溶栓组15例。溶栓组单纯尿激酶溶栓，碎栓组联合碎栓和抗凝治疗。比较两组疗效及并发症差异。结果碎栓组复通例数、复通后使用时间、尿激酶用量均优于溶栓组[13例比7例，（22．13±17．51）个月比（11．05±10．55）个月，（40．48±22．26）万IU 比（60．29±15．81）万IU，χ2＝5．40，t＝2．10，均P＜0．05，t＝2.81，P＜0．01]；并发症方面，两组出血例数差异无统计学意义（2例比3例，χ2＝0．24，P＞0．05），碎栓组复通后再栓塞例数较溶栓组少（2例／13例比4例／7例，χ2＝3．85，P＜0．05），但脏器栓塞例数高（4例比0例，χ2＝4．62，P＜0．05）。结论与传统尿激酶溶栓治疗相比，联合导丝碎栓和低分子肝素抗凝治疗，内瘘复通率高，再次栓塞率低，未增加出血并发症发生率，可延长内瘘使用寿命，但易致严重脏器栓塞，故需严格掌握适应证，仅适用于单纯溶栓疗效欠佳无法再次手术者。
目的：分析常規尿激酶溶栓聯閤跼部導絲碎栓和低分子肝素抗凝治療血液透析患者動靜脈內瘺栓塞的療效，探討其應用前景。方法30例血液透析動靜脈內瘺栓塞患者，根據自願原則分為碎栓組15例和溶栓組15例。溶栓組單純尿激酶溶栓，碎栓組聯閤碎栓和抗凝治療。比較兩組療效及併髮癥差異。結果碎栓組複通例數、複通後使用時間、尿激酶用量均優于溶栓組[13例比7例，（22．13±17．51）箇月比（11．05±10．55）箇月，（40．48±22．26）萬IU 比（60．29±15．81）萬IU，χ2＝5．40，t＝2．10，均P＜0．05，t＝2.81，P＜0．01]；併髮癥方麵，兩組齣血例數差異無統計學意義（2例比3例，χ2＝0．24，P＞0．05），碎栓組複通後再栓塞例數較溶栓組少（2例／13例比4例／7例，χ2＝3．85，P＜0．05），但髒器栓塞例數高（4例比0例，χ2＝4．62，P＜0．05）。結論與傳統尿激酶溶栓治療相比，聯閤導絲碎栓和低分子肝素抗凝治療，內瘺複通率高，再次栓塞率低，未增加齣血併髮癥髮生率，可延長內瘺使用壽命，但易緻嚴重髒器栓塞，故需嚴格掌握適應證，僅適用于單純溶栓療效欠佳無法再次手術者。
목적：분석상규뇨격매용전연합국부도사쇄전화저분자간소항응치료혈액투석환자동정맥내루전새적료효，탐토기응용전경。방법30례혈액투석동정맥내루전새환자，근거자원원칙분위쇄전조15례화용전조15례。용전조단순뇨격매용전，쇄전조연합쇄전화항응치료。비교량조료효급병발증차이。결과쇄전조복통례수、복통후사용시간、뇨격매용량균우우용전조[13례비7례，（22．13±17．51）개월비（11．05±10．55）개월，（40．48±22．26）만IU 비（60．29±15．81）만IU，χ2＝5．40，t＝2．10，균P＜0．05，t＝2.81，P＜0．01]；병발증방면，량조출혈례수차이무통계학의의（2례비3례，χ2＝0．24，P＞0．05），쇄전조복통후재전새례수교용전조소（2례／13례비4례／7례，χ2＝3．85，P＜0．05），단장기전새례수고（4례비0례，χ2＝4．62，P＜0．05）。결론여전통뇨격매용전치료상비，연합도사쇄전화저분자간소항응치료，내루복통솔고，재차전새솔저，미증가출혈병발증발생솔，가연장내루사용수명，단역치엄중장기전새，고수엄격장악괄응증，부괄용우단순용전료효흠가무법재차수술자。
Objective To analyze the curative effect used the common urokinase thrombolysis combined with topo-guide-wire fragmentation and low molecular heparin in the treatment of hemodialysis patients with arteriove-nous fistula embolization and explore the prospects of its application.Methods 30 hemodialysis patients with arterio-venous fistula embolization were divided into 15 cases of thrombolysis group and 15 cases of thrombectomy group ac-cording to the voluntary.The thrombolysis group was given simple urokinase thrombolysis,and the thrombectomy group was given thrombectomy combined with anticoagulant therapy.The curative effect and the difference in complication were compared.Results In curative effect,the recanalization rate,using time after recanalization,and dosage of uro-kinase of the thrombectomy group were better than those of the thrombolysis group[13cases vs.7cases,(22.13 ± 17.51)months vs.(11.05 ±10.55)months,(40.48 ±22.26)ten thousands IU vs.(60.29 ±15.81)ten thousands IU,χ2 =5.40,t=2.10,all P<0.05,t=2.81,P<0.01].In complication,there was no difference in the number of bleeding cases between the two groups(2cases vs.3cases,χ2 =0.24,P>0.05).For the thrombectomy group,there were fewer cases of re -embolization after recanalization (2 cases/13 cases vs.4 cases/7 cases,χ2 =3.85,P <0.05),but more cases of organ embolism(4 cases vs.0 cases,χ2 =4.62,P<0.05).Conclusion Compared with the traditional urokinase thrombolytic therapy,the guide wire fragmentation combined with low molecular weight hepa-rin anticoagulant therapy has a higher fistula recanalization rate and a lower re-embolization rate.It does not increase the incidence of bleeding complications.Besides,it can extend the use of internal fistula.However,it may cause the serious organ embolism,so it is necessary to strictly grasp the indications,applying only to the patients who are in the poor efficiency of thrombolytic and unable to have another operation.
