摘要
目的 讨论在长期带Cuff中心静脉导管的维持性血液透析患者封管时应用肝素钠与枸橼酸钠的临床效果与安全性.方法 选取本院行长期带Cuff中心静脉导管的维持性血液透析患者48例参与本次调查,依据随机对照研究的方式将患者划分为实验组（n=24）和对照组（n=24）,分别使用肝素钠与枸橼酸钠进行封管处理,观察6个月,尔后统计比较两组患者透析血流量、导管相关感染（CRIs）、导管内血栓等的差异,并测定观察前后患者血清钙离子（Ca2＋）、镁离子（Mg2＋）、门冬氨酸氨基转氨酶（AST）、丙氨酸转氨酶（ALT）的变化情况.对比两组观察前后凝血功能、血红蛋白及血小板计数变化情况.同时记录患者不良反应发生情况.结果 进行为期6个月的观察,对照组共行血液透析955次,实验组共行血液透析962次,实验组的CRIs发生次数相较于对照组显著降低（P＜0.05）,而尿激酶封管次数则明显高于对照组（P＜0.05）,两组在导管内可抽吸血栓次数与导管功能不良发生次数上未见明显差异（P＞0.05）;两组观察前后Ca2＋、Mg2＋、AST及ALT均未见明显变化（P＞0.05）;两组观察前PT、APTT、血红蛋白及血小板计数无显著差异.实验组观察后PT及APTT均显著高于对照组（P＜0.05）.两组观察后血红蛋白无显著差异.两组血小板计数在观察后显著上升（P＜0.05）,但两组观察后血小板计数对比无显著差异（P＞0.05）;两组均未见严重不良反应,仅对照组有2例出现胃肠道不适症状,可自行缓解.结论 枸橼酸钠用于维持性血液透析患者长期带Cuff中心静脉导管的封管时有助于减少导管相关感染事件的发生,且不良反应少,安全性较高,但可能增加导管内血栓的形成风险,临床应根据患者的具体情况合理选择,以进一步确保抗凝剂使用的安全性.
Objectives To investigate long-term efficacy and safety of sodium citrate and heparin in locking central cenous hemodialysis catheter.Methods 48 hemodialysis patients with longterm cuffed catheter in our hospital were enrolled into this study.All patients were randomly divided into the experimental group （n =24） and the control group （n =24）,and locked central vein with citrate and heparin.The dialysis blood flow,catheter related infection （CRIS）,catheter thrombosis differences,changes of serum calcium ion （Ca2＋）,magnesium ions （Mg2＋）,aspartate amino acid transaminase （AST） and alanine aminotransferase （ALT） were observed and compared before and after operation.The changes of coagulation function,hemoglobin,blood platelet count and adverse reactions were compared between the two groups.Results 955 sessions？ of hemodialysis in the control group and 962 sessions of hemodialysis in the experiment group were performed during 6 months.Frequency of CRIs in the experimental group was significantly lower than the control group （P 〈 0.05）,and the locking frequency of urokinase was significantly more than that of the control group （P 〈 0.05）.There were no significant differences in the number of thrombus aspiration catheter,adverse reactions,Ca2 ＋,Mg2 ＋,AST and ALT between the two groups before and after operation （P 〉 0.05）.PT,APTT,hemoglobin and platelet count had no significant difference between the two groups.The PT and APTT in the experimental group were significantly higher than in the control group （P 〈 0.05）.No serious adverse reaction happened in the two groups except gastrointestinal symptoms in 2 patients.Conclusions Sodium citrate and heparin in locking central vein hemodialysis catheter has advantages of less incidence of catheter-related infection events,and less adverse reaction,higher security,but it may increase the risk of catheter thrombus.A reasonable treatment should be considered on a case-by case basis to ensure usage safety of anticoagulant.
作者
王方利
Wang Fangli.(Department of Nephrology, the First people＇s Hospital of Pingyuan county, Pingyuan 253100, China)
出处
《国际泌尿系统杂志》
2016年第6期899-903,共5页
International Journal of Urology and Nephrology
关键词
肾透析
抗凝药
Renal Dialysis
Anticoagulants
