潘覃 刘安国 郭亮

【摘要】 目的：探討超声引导下留置针置入在动静脉内瘘溶栓中的临床效果，提高内瘘溶栓成功率。方法：选择笔者所在科2016年8月-2018年12月收治的40例动静脉内瘘闭塞24 h内的患者，根据入院顺序将其分为对照组（20例）和研究组（20例）。对照组采用留置针盲穿法，研究组采用超声引导下留置针置入。比较两组患者一次性留置针穿刺成功率、穿刺平均时间，溶栓过程中留置针并发症发生率、溶栓成功率。结果：研究组一次性穿刺成功率高于对照组，穿刺平均时间明显短于对照组，差异均有统计学意义（P<0.01）。研究组溶栓过程中留置针并发症发生率低于对照组，差异有统计学意义（P<0.05），两组患者在溶栓过程中均未出现严重并发症。研究组内瘘溶栓成功率高于对照组，差异有统计学意义（P<0.05）。结论：超声引导下留置针置入在动静脉内瘘溶栓中，操作简单，一次性穿刺成功率高，穿刺时间短，可减少反复穿刺给患者带来的痛苦，并发症少，溶栓效果显著，值得推广。

【关键词】 超声引导下留置针置入 动静脉内瘘 溶栓治疗

doi：10.14033/j.cnki.cfmr.2019.30.025 文献标识码 B 文章编号 1674-6805（2019）30-00-03

[Abstract] Objective： To investigate the clinical effect of ultrasound guided indwelling needle in thrombolysis of arteriovenous fistula and improve the success rate of thrombolysis of arteriovenous fistula. Method： A total of 40 patients with arteriovenous fistula occlusion within 24 h admitted in our department from August 2016 to December 2018 were selected， and they were divided into the control group （20 cases） and the study group （20 cases） according to the order of admission. The control group was treated with blind puncture of indwelling needle， while the study group was treated with ultrasound-guided indwelling needle. The success rate of one-time indwelling needle puncture， the average puncture time， the incidence of complication of indwelling needle during thrombolysis and the success rate of thrombolysis were compared between the two groups. Result： The success rate of one-time puncture in the study group was higher than that in the control group，and the average time of puncture was shorter than that in the control group， the differences were statistically significant （P<0.05）. The incidence of complications of indwelling needle during thrombolysis in the study group was lower than that of the control group， the difference was statistically significant （P<0.05）. No serious complications occurred during thrombolysis in the two groups. The success rate of thrombolysis in the study group was higher than that in the control group， the difference was statistically significant （P<0.05）. Conclusion： Ultrasound-guided indwelling needle placement in thrombolysis of arteriovenous fistula is simple in operation， high success rate of one-time puncture and short puncture time. It can reduce the pain caused by repeated puncture， with fewer complications and remarkable thrombolytic effect. It is worth popularizing.

[Key words] Ultrasound-guided indwelling needle placement Arteriovenous fistula Thrombolytic therapy

First-authors address： Zigong First Peoples Hospital， Zigong 643000， China

自体动静脉内瘘是维持性血液透析患者最佳的血管通路，被称为透析患者的生命线[1]。动静脉内瘘血栓形成是最常见的并发症。相关文献报道，自体动静脉内瘘血栓发生率高达14%～36%，给透析患者的通路使用年限、生存质量带来严重的影响[2]。美国肾脏病基金会肾脏病生存质量指導指南（NTK-K/DOQZ）指出，24 h内血栓形成可行紧急溶栓治疗[3]。笔者所在医院血液净化中心应用超声引导下留置针置入内瘘血栓配合尿激酶、低分子肝素钙、手法按摩，治疗动静脉内瘘血栓形成取得良好效果，现报道如下。

1 资料与方法

1.1 一般资料

选择笔者所在科2016年8月-2018年12月收治的40例动静脉内瘘闭塞24 h内的患者，其中男24例，女16例;原发病为慢性肾小球肾炎12例，高血压10例，糖尿病8例，肾病综合征5例，多囊肾4例，狼疮性肾病1例;平均年龄（57.0±12.3）岁;平均透龄（62.0±12.3）个月;平均内瘘使用年限（2.88±1.20）年。……