摘要
目的分析定期尿激酶封管对血液透析患者凝血因子Ⅻ(FⅫ)、D-二聚体(D-D)、抗凝血酶Ⅲ(ATⅢ)水平和深静脉置管感染的影响。方法以2018年7月-2019年12月浙江省杭州市萧山区中医院血液净化中心收治的需进行血液透析的患者148例为研究对象,采用随机数字表法分为对照组和试验组,各74例。对照组采用肝素盐水封管,试验组采用定期尿激酶联合肝素封管。比较两组一般资料和透析后深静脉置管感染率,比较两组透析前后导管通畅性相关指标、血浆凝血指标FⅫ、D-D、ATⅢ水平和透析后留置导管不良事件发生情况。结果透析后,试验组深静脉置管感染发生率为2.70%,低于对照组的20.27%(P<0.05)。透析后,试验组透析血流量、尿素清除指数较透析前升高,且试验组高于对照组;导管静脉压较透析前降低(P<0.05),且试验组低于对照组(P<0.05)。透析后,两组血浆FⅫ、D-D水平较透析前均降低,试验组低于对照组(P<0.05),而ATⅢ水平较透析前升高,试验组高于对照组(P<0.05)。透析后,试验组导管栓塞率4.05%低于对照组29.73%,导管栓塞发生时间晚于对照组(P<0.05)。结论用尿激酶对血液透析患者进行定期封管,能降低患者血浆FⅫ、D-D水平,升高ATⅢ水平,显著改善患者凝血功能和导管通畅性,降低或延迟导管栓塞的发生,有利于降低深静脉置管感染的发生风险。
OBJECTIVE To analyze the effect of regular urokinase catheter sealing on coagulation factor Ⅻ(FⅫ), D-dimer(D-D) and antithrombin Ⅲ(ATⅢ) levels and deep vein catheter infection in dialysis patients. METHODS A total of 148 patients requiring dialysis admitted to the hematology department of Xiaoshan District Traditional Chinese Medicine Hospital, Hangzhou City, Zhejiang Province from Jul. 2018 to Dec. 2019 were recruited, which were randomly divided into the control group and observation group by using random number table method, with 74 cases in each group. Catheter sealing in the control group was with heparin saline, and that innthe observation group was with regular urokinase combined with heparin. The general data and the infection rate of deep vein catheterization after dialysis between the two groups were compared. The related indexes of catheter patency, plasma coagulation indexes such as FⅫ, D-D and ATⅢ levels before and after dialysis, and adverse events of catheter indwelling after dialysis were compared between the two groups. RESULTS After dialysis, the incidence of deep vein catheter infection in the observation group was 2.70%, which was significantly lower than 20.27%(P<0.05) of that in the control group. After dialysis, the dialysis blood flow and urea clearance index in the observation group were significantly higher than those before dialysis, and the catheter venous pressure was significantly lower than that before dialysis(P<0.05). After dialysis, the dialysis blood flow and urea clearance index in the observation group were significantly higher than those in the control group, and the catheter venous pressure in the observation group was significantly lower than that in the control group(P<0.05). After dialysis, the levels of plasma FⅫ and D-D between two groups were significantly lower than those before dialysis, and indexes in the observation group was significantly lower than those in the control group(P<0.05). Although, the level of ATⅢ was higher after dialysis than before, which in the observation group was significantly higher than that in the control group(P<0.05). After dialysis, the rate of catheter embolization in the observation group(4.05%) was significantly lower than that in the control group(29.73%), and the occurrence time of catheter embolization was significantly later than that in the control group(P<0.05). CONCLUSION Regular sealing with urokinase in hemodialysis patients can reduce the plasma FⅫ and D-D levels and increase ATⅢ level, significantly improve the normalization of coagulation and catheter patency in patients, reduce the occurrence of catheter embolism, and may be conducive to reducing the risk of deep vein catheterization infection.
作者
陈亚萍
顾新丽
王志红
CHEN Ya-ping;GU Xin-li;WANG Zhi-hong(Xiaoshan District Hospital of Traditional Chinese Medicine,Hangzhou,Zhejiang 311200,China)
出处
《中华医院感染学杂志》
CAS
CSCD
北大核心
2021年第7期1111-1115,共5页
Chinese Journal of Nosocomiology
基金
浙江省自然科学基金资助项目(2019738)。
