血液透析患者动静脉内瘘血栓形成的治疗方法探讨

目的总结血液透析患者动静脉内瘘后血栓形成的治疗经验。方法 156例动静脉内瘘后血栓形成患者,早期采用溶栓治疗,而晚期采用手术治疗。结果 47例采用溶栓治疗,成功率为53.2%,其中6h内、6h后溶栓成功率分别为85.7%、26.9%(P<0.01)。131例(含溶栓失败22例)手术治疗者中,成功率为84.7%,其中静脉-动脉端侧吻合、取栓加吻合口扩张的成功率分别为94.2%、48.1%(P<0.01)。结论动静脉内瘘后血栓形成患者在阻塞6h内采用溶栓治疗,而阻塞超过72h者首选静脉-动脉端侧吻合手术。

Therapeutic experience of thrombosis after internal arteriovenous fistula in hematodialysis patients

Objective To summarize the therapeutic experience of thrombosis after internal arteriovenous fistula in hema- todialysis patients. Methods A total of 156 cases of thrombosis after internal arteriovenous fistula were enrolled. The throm- bolytic and operative treatments were performed on early and late cases, respectively. Results Among 47 patients undergoing thrombolytic therapy, the overall success rate was 53.2%, and the success rate within 6 hours was higher than that after 6 hours （85.7% vs 26.9%, P〈0.01）. Of 131 cases （including 22 cases of thrombolytic failure） undergoing operative treatment, the overall success rate was 84.7%, and the success rate of venous-arterial end to side anastomosis was superior to that of embolectomy plus anastomotic expansion （94.2% vs 48.1%, P〈0.01）. Conclusion The thrombolytic therapy is suitable for 6-hour thrombosis after internal arteriovenous fistula, while the venous-arterial end to side anastomosis is optimal for 72-hour thrombosis in hematodialysis patients.