With the continuous development of blood purification technology, continuous research and development of artificial blood vessels, and increasingly mature surgery, the number of patients undergoing the artificial arterio venous fistula (AVG) surgery has gradually increased in recent years. However, acute thrombosis and vascular stenosis are the most common complications of AVG due to repeated puncture and compression. Here I would like to share with you the successful thrombolytic treatment of urokinase in our center as follows:
There were 6 patients, including 4 males and 2 females, aged 49 ~ 76 years old. The primary disease was chronic glomerulonephritis in 2 patients and diabetic nephropathy in 3 patients. Anca-related vascutitis occurred in 1 patient, and 6 patients underwent hematopoietic tube transplantation due to their poor vascular conditions. The patients were treated with artificial vascular puncture dialysis 15 days to 3 months after the operation, respectively, and the internal fistula murmur disappeared through auscultation. The blockage time of the internal fistula was 10 ~ 72 h, the surface of the internal fistula failed to touch the vessel tremor, no blood flow murmur was detected, the thrombosis was confirmed by color ultrasound examination, and its location and length were marked.
Methods of thrombolysis:
Routine biochemical examination of fibrinogen (Fbg), prothrombin time (PT), thrombin time (TT), partial thrombin activation time (a PTT), biochemical indicators of liver and kidney function before and after treatment, and observation of adverse reactions (rash, fever, bleeding and embolism, etc.). Combined with auscultation, palpation and b-ultrasound localization of blood vessels, the site of thrombosis was identified, and a total of 2 points, including the arterial end of anastomosis and the venous end of anastomosis, were selected for cardiac puncture. As far as possible to reduce damage and bleeding, using a small needle injection, respectively, with no. 5.5 the scalp needle connection 5 ml syringe with sterile saline solution, on the bevel puncture, the needle puncture has frustrated feeling and see h. along the direction of blood vessels into the needle again after a few, properly fixed after withdrawing have h., each point of prescribed for 0.9% sodium chloride injection 50 ml 200000 U + urokinase, respectively connected to the micro pump intravenous injection, typically 2 to 3 hours after injection. The total amount of urokinase depends on the thrombolytic effect, and generally does not exceed 500,000 U at 12h. Results urokinase thrombolysis was performed 8 times in 6 patients, 4 patients were treated with the first thrombolysis, and the other 2 patients were treated with more than 3 discontinuations. After thrombolytic treatment, the fistula was transfixed within 4-12h with a success rate of 100%. Thrombolytic therapy was mainly performed by simultaneous puncture of the arteries and veins, and there was no case of pulmonary embolism, cerebral embolism or other complications.
Notes for thrombolysis:
1. Recanalization of fistula is closely related to occlusion time. Early thrombolysis is the key to treatment.
2. Strictly control the drip rate, observe the condition closely, and observe whether there is bleeding tendency after thrombolysis, such as skin, sclera, teeth, puncture point, digestive tract, etc.; Report any problems to the doctor and deal with them properly.
3. During thrombolysis, patients should stay in bed absolutely and avoid getting out of bed. The potential and most serious complication of thrombolytic therapy is pulmonary embolism. During nursing, the patient's condition was observed closely, subjective feelings were asked, and clinical manifestations of embolism such as cough, chest tightness and hemoptysis were observed. In the process of thrombolysis, defibrillator, ecg monitor, atropine, lidocaine and other drugs should be prepared for emergency use.
Encourage patients to take the initiative to participate in the management of blood vessels, improve the ability of self-protection, monitor the blood vessel pulse 5-6 times a day, and go to the hospital immediately if the tremor disappears or weakens, the murmur disappears, the blood vessel collapses and stiffens. The compression time of internal fistula after dialysis should not be too long, and finger pressure (15 ~ 20 minutes) is advisable. For patients prone to hypotension during dialysis, water should be controlled and dry body weight should be appropriately increased. For patients with hypercoagulability, the dosage of anticoagulant should be adjusted appropriately, and antithrombotic drugs should be taken as prescribed by the doctor during the dialysis period.
Different from the internal fistula, the artificial hematopoietic fistula is not easy to repair after the fiber damage in the tube wall, and only relies on the hyperplasia of connective tissue around the tube to fill it. Therefore, preventing complications and prolonging its service life are very important to improve patients' quality of life.
Locally as a kind of relatively high concentrations of urokinase thrombolysis treatment of minimally invasive treatment method, simple, safe, effective and economic, etc., can be specific to activate fibrinolytic enzyme, hydrolysis fibrin to dissolve thrombus, possesses the advantages of short half-life, the price is cheap, can make the thrombolysis more fully, reduce the embolic loss made significant curative effect in clinic, is human hematopoietic tube fistula in treatment of thrombosis.