血液透析患者人造血管内瘘闭塞后溶栓治疗的护理
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摘要
目的探讨血液透析患者人造血管内瘘闭塞后溶栓治疗的护理方法。方法采用尿激酶溶栓和肝素钠抗凝治疗,同时在治疗前后采取针对性护理措施。结果 98例人造血管内瘘患者中,对11例18例次出现人造血管内瘘闭塞的患者采用尿激酶溶栓治疗,14例次溶栓成功、内瘘恢复血流,4例次溶栓无效后经Fogarty导管取栓治疗恢复内瘘功能,其中除2例次出现穿刺点出血外,其他未见并发症。结论人造血管内瘘闭塞后采取针对性的治疗及护理措施,是提高人造血管内瘘溶栓成功率的关键。
Objective To explore the nursing care of hemodialysis patients receiving thrombolytic therapy for the treatment of occlusion of arteriovenous graft fistula.Method The patients with occlusion of arteriovenous graft fistula received thrombolytic therapy with urokinase and anticoagulant therapy with heparin sodium as well as proper nursing care during the treatment.Results Among the 98 patients with arteriovenous graft fistula,occlusion happened 18 times in 11 patients.After thrombolytic therapy with urokinase,blood flow of fistula restored 14 times,and the others were treated by Fogarty catheter thrombectomy,but two cases suffered from bleeding on the puncture site.Conclusion Proper and timely treatment and nursing care for graft fistula occlusion are key points to improve the success rate of fistula thrombolysis.
Objective To explore the nursing care of hemodialysis patients receiving thrombolytic therapy for the treatment of occlusion of arteriovenous graft fistula.Method The patients with occlusion of arteriovenous graft fistula received thrombolytic therapy with urokinase and anticoagulant therapy with heparin sodium as well as proper nursing care during the treatment.Results Among the 98 patients with arteriovenous graft fistula,occlusion happened 18 times in 11 patients.After thrombolytic therapy with urokinase,blood flow of fistula restored 14 times,and the others were treated by Fogarty catheter thrombectomy,but two cases suffered from bleeding on the puncture site.Conclusion Proper and timely treatment and nursing care for graft fistula occlusion are key points to improve the success rate of fistula thrombolysis.
引文
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[14]何剑零,蒋欣欣,叶有新.提高移植物动静脉内瘘开通率的体会[J].中华肾脏病杂志,2011,27(6):454-455.
[2]叶朝阳.血液透析血管通路的理论与实践[M].上海:上海医科大学出版社,2001:123-124.
[3]王玉柱.血液进化通路[M].北京:人民军医出版社,2009:116-117.
[4]威廉.L.亨里奇,马腾骧,王林,等.透析原理与实践[M].沈阳:辽宁科学技出版社,2007:61-62.
[5]汪忠镐,张建,谷涌泉.实用血管外科与血管介入治疗学[M].北京:人民军医出版社,2004:114-537.
[6]汪忠镐.血管外科学[M].杭州:浙江科学技术出版社,2010:1564.
[7]Cynamon J,Pierpont C E.Thrombolysis for the treatment of thrombosedhemodialysis access grafts[J].Rev Cardiovasc Med,2002,3(Suppl 2):75-82.
[8]Tseke P,Kalyveza E,Politis E,et al.Thrombolysis with alteplase:a non-invasive treatment for occluded arteriovenous fistulas and grafts[J].ArtifOrgans,2011,35(1):58-62.
[9]Schon D,Mishler R.Pharmacomechanical thrombolysis of natural veinfistulas:reduced dose of TPA and long-term follow-up[J].Semin Dial,2003,16(3):272-275.
[10]郭相江,赵意平,施娅雪,等.尿激酶溶栓治疗人工血管动静脉内瘘急性血栓形[J].中国血液净化,2011,10(4):198-200.
[11]伍丽珍,沈雪美,王维红,等.内瘘闭塞的原因分析及溶栓方法探讨[J].现代护理,2006,12(7):643.
[12]Jeon UB,Kim CW,Chung SW.Percutaneous treatment of thrombosedprosthetic brachial-basilic access by the transradial approach[J].J VascSurg,2009,49(4):1057-1059.
[13]美国NKF-K/DOQI工作组.慢性肾脏病及透析的临床实践指南[M].北京:人民卫生出版社,2003:473-487.
[14]何剑零,蒋欣欣,叶有新.提高移植物动静脉内瘘开通率的体会[J].中华肾脏病杂志,2011,27(6):454-455.