小剂量尿激酶滴注并封管预防老年透析患者导管通路形成纤维蛋白鞘的临床疗效

发布时间：2019-02-20 20:02

【摘要】：目的观察小剂量尿激酶滴注并封管预防老年长期血液透析患者导管通路形成纤维蛋白鞘的临床疗效。方法选取置入中心静脉导管并行长期血液透析的老年慢性肾衰竭患者41例,按照数字随机法分为A组(21例)和B组(20例),均给予Palindrome导管置管,透析完成后A组常规肝素封管,B组在透析置管同侧静脉滴注10万U尿激酶,然后10万U尿激酶封管。随访6个月,记录两组导管功能不良事件,根据血管彩超结果评估有无纤维蛋白鞘,检测6个月时导管血流速度及患者凝血功能等。结果 B组导管功能不良率、纤维蛋白鞘形成率及血栓形成率均显著低于A组(均P0.05)。置管2 w、6个月后两组均未出现明显凝血功能异常,B组凝血酶原时间(PT)较A组明显延长(P0.05),但两组活化部分凝血活酶时间(APTT)、国际化标准比值(INR)均无明显差异(均P0.05)。置管6个月后,B组平均透析血流量、尿素清除指数(Kt/V)明显高于A组(均P0.05)。结论尿激酶预防治疗可有效避免Palindrome导管内形成纤维蛋白鞘,且小剂量使用安全性较高,无明显出血。
[Abstract]:Objective to observe the clinical effect of small dose urokinase infusion and catheter sealing on the prevention of fibrin sheath formation through catheter pathway in elderly patients with long term hemodialysis. Methods 41 elderly patients with chronic renal failure who were treated with central venous catheter and long-term hemodialysis were randomly divided into group A (21 cases) and group B (20 cases). All patients were treated with Palindrome catheter. After dialysis, 100000 U urokinase was injected intravenously in group A and 100000 U urokinase in group B, respectively. The patients were followed up for 6 months to record the adverse events of catheter function, and to evaluate the presence of fibrin sheath according to the results of color Doppler ultrasound, and to detect the blood flow velocity of the catheter and the coagulation function of the patients at 6 months. Results the incidence of ductal dysfunction, fibrin sheath formation and thrombosis in group B were significantly lower than those in group A (P0.05). After two weeks of catheterization, there was no obvious coagulation abnormality in both groups after 6 months. The prothrombin time (PT) in group B was significantly longer than that in group A (P0.05), but the activated partial thromboplastin time (APTT),) in group B was significantly longer than that in group A (P0.05). There was no significant difference in internationalization standard ratio (INR) (P0.05). After 6 months of catheterization, the average dialysis blood flow and urea clearance index (Kt/V) in group B were significantly higher than those in group A (P0.05). Conclusion urokinase prophylaxis can effectively prevent fibrin sheath from forming in Palindrome catheter.
【作者单位】：武汉市武昌医院内五科;
【基金】：武汉市卫生局科研项目(No.WX15C19)
【分类号】：R692.5

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