摘要
目的比较观察两种不同的尿激酶应用方式在已发生长期中心静脉置管功能不良的患者中的应用效果。方法选择2013年10月至2017年7月在我院血液净化中心借助长期中心静脉置管行血液透析的患者62例,所有患者在透析期间均有中心静脉置管功能不良发生。62例患者随机分为2组。每次透析开始前,按导管长度将含2.5万U/mL的尿激酶分别从动静脉导管端口注入,溶栓30 min后测试导管通畅性,如不通畅,可重复1~2次再开始血液透析。观察组(31例)透析结束后,采用肝素+尿激酶(生理盐水2 mL+肝素12 500U+尿激酶10万U)按导管标记量封管;对照组(31例)透析结束后,采用常规肝素封管(生理盐水2 mL+肝素12 500 U)。观察两组患者的长期静脉置管功能及并发症的发生情况,观察治疗前后的凝血指标。结果观察组血液透析流量可达到(205.8±37.9)mL/min,高于对照组的(185.6±33.2)mL/min,观察组血液透析过程中静脉压、跨膜压、停止透析前溶栓时间均低于对照组(P<0.05),而两组患者出现导管感染及发生出血的例数均较少,两组比较差异无统计学意义(P>0.05)。观察组治疗前后凝血功能比较差异无统计学意义(P>0.05)。结论透析前尿激酶溶栓、透析后尿激酶+肝素混合封管的方式安全、有效,护理人员操作简便,不良反应小,不需住院治疗,再通的成功率高,较透析后单纯肝素封管提升了透析的血流量,缩短了管路再通的时间,避免了因中心静脉置管功能不良而导致的拔管,减少了患者的经济支出,安全有效。
Objective To compare the effects of different methods of urokinase use on long-term central venous catheter dysfunction. Methods Totally 62 cases of long-term central venous catheterization hemodialysis in Blood Purification Center of our hospital from October 2013 to July 2017 were divided into 2 groups randomly. All the patients had central venous catheter dysfunction during dialysis. Before each time of dialysis,urokinase 25 000 U/mL was injected into arteriovenous catheter according to the length of the catheter. The patency of catheter was tested after thrombolysis for 30 min. The thrombolysis would be repeated for 1 - 2 times if the catheter was obstructed before hemodialysis.After dialysis,heparin ＋ urokinase（ NS 2 mL ＋ heparin 12 500 U ＋ urokinase 100 000 U） was used in observation group to seal the catheter,while normal heparin seal was used（ NS 2 mL ＋ heparin 12 500 U） in control group. The long-term venous catheter function and the incidence of complications were observed,and the coagulationindexes were compared before and after treatment. Results The flow rate of hemodialysis in observation group was higher than that of control group：（ 205. 8 ± 37. 9） mL/min vs.（ 185. 6 ± 33. 2） mL/min,P〈0. 05. The venous pressure and transmembrane pressure during dialysis in observation group were lower than those of control group（ P〈0. 05）,and the thrombolytic time before stopping dialysis was shorter（ P〈0. 05）. There were a few cases of catheter infection and bleeding in the two groups,and no significant difference was found between them（ P〉0. 05）. There was no statistical difference in the coagulation function before and after treatment in observation group. Conclusion Pre-dialysis thrombolysis with urokinase combined with urokinase ＋ heparin sealing after dialysis is safer and more effective,which is simple for nurses to operate and can reduce the adverse reactions. It has the advantages of no hospitalization and high success rate of recanalization,improving blood flow of dialysis compared to the simple heparin sealing tube after dialysis and shortening the time of recanalization,and it can avoid the extubation caused by the dysfunction of central venous catheter and reduce the patients＇ cost.
出处
《实用药物与临床》
CAS
2018年第2期178-181,共4页
Practical Pharmacy and Clinical Remedies
关键词
尿激酶
长期静脉置管
功能不良
Urokinase
Long-term venous catheterization
Dysfunction
