中国血液净化

中国血液净化 ›› 2016, Vol. 15 ›› Issue (06): 341-343.doi: 10.3969/j.issn.1671-4091.2016.06.007

• 血管通路 • 上一篇    下一篇

定期尿激酶联合肝素封管对预防血液透析长期导管感染的观察

任月运,李红梅   

  1. 徐州市第三人民医院（肿瘤医院）肾内科
  • 收稿日期:2015-12-21 修回日期:2016-04-11 出版日期:2016-06-12 发布日期:2016-06-19
  • 通讯作者: 李红梅 hongmei19870113@126.com E-mail:hongmei19870113@126.com

Observation of regularly urokinase combined heparin sealed tube to the long-term hemodialysis catheter tube in prevention of infection

  • Received:2015-12-21 Revised:2016-04-11 Online:2016-06-12 Published:2016-06-19

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摘要： 目的研究定期尿激酶联合肝素封管对血液透析患者长期导管预防感染的影响，阐明定期应用尿激酶联合肝素封管的临床意义。方法选用2014 年4 月～2015 年3 月在徐州市第三人民医院透析中心使用右颈内静脉带cuff 长期透析导管作为血管通路行维持性血液透析患者60 例，随机分为2 组(实验组和对照组各30 例)，观察期12 个月。实验组每周1 次尿激酶联合肝素盐水封管，其余透析后肝素盐水封管；对照组单纯采用肝素盐水封管。结果实验组可以明显降低导管的感染发生率(3.3%比20.0%,χ2=4.043，P=0.044)；实验组治疗前后凝血酶原时间[(13.93±1.82)s 比(13.89±1.92)s，t=3.129，P=0.894]、血小板[(190.59±49.65)×109/L 比(193.91± 39.68)×109/L，t=0.393，P=0.617]、国际标准化比值[(1.20±0.20)s 比(1.21±0.15)s，t=0.619，P=0.751]、活化的部分凝血活酶时间[(33.85±6.51)s 比(33.99 ± 7.12) s，t=0.297，P=0.814]、纤维蛋白原[(2.98±0.78)g/L 比(3.06±0.76)g/L，t=0.706，P=0.483]、凝血酶时间[(11.37±1.59)s 比(11.91±1.54)s，t=0.587，P= 0.523] 差异无统计学意义。结论定期应用尿激酶联合肝素封管，对维持性血液透析患者长期导管能减少感染的发生率，对预防相关性菌血症安全有效。

关键词: 血液透析, 尿激酶, 导管

Abstract: Objective To research the influence of regularly urokinase and heparin sealed tube to the long-term hemodialysis catheter tube in prevention of infection, so as to find out the clinical significance of regular application of urokinase and heparin seal tube. Methods We selected 60 patients using right internal jugular vein long-term indwelling catheter with cuff as vascular access line maintenance hemodialysis during April 2014-March 2015 in our hospital dialysis centers, and randomly divided them into two groups (the experimental group and control group, each group of 30 patients). The experimental group with a catheter-locking
regimen of urokinase and heparin once weekly ,with heparin used in the other sessions.; The control group only with a catheter-locking regimen of heparin. Results The experimental group can obviously reduce the incidence rate of catheter infection (3.3% vs. 25%；χ2=4.043，P=0.044); In the experimental group before and after treatment ,there were no significant changes in PT[(13.93±1.82)s vs. 13.89±1.92)s，t=3.129，P=0.894]、PLT[(190.59±49.65)×109/L vs. (193.91±39.68)×109/L，t=0.393，P=0.617]、INR [(1.2±0.20 )s vs. (1.21± 0.15)s，t=0.619，P=0.751]、APTT [(33.85±6.51)s vs. (33.99±7.12)s，t=0.297，P=0.814]、FIB [(2.98±0.78)g/L vs. (3.06±0.76)g/L，t=0.706，P=0.483]and TT [(11.37±1.59)s vs. (11.91±1.54)s，t=0.587，P=0.523]. Conclusion Regularly urokinase and heparin sealed tube to the long-term hemodialysis catheter tube can reduced the incidence of infection , It is safe and effective to prevention of catheter-related bacteremia.

Key words: Hemodialysis, Urokinase, Catheter tube