中国血液净化

中国血液净化 ›› 2026, Vol. 25 ›› Issue (01): 59-63.doi: 10.3969/j.issn.1671-4091.2026.01.014

• 血管通路 • 上一篇    下一篇

尿激酶不同溶栓方式对带隧道带涤纶套中心静脉导管通畅性的影响

王方圆   宋 利   尹 燕   徐清秀   崔冬梅   赵立艳   周清华   廖俊杰   陈 诚   胡宇航   黄 欣   冯仲林   

  1. 510080 广州，1南方医科大学附属广东省人民医院(广东省医学科学院)肾内科
  • 收稿日期:2025-05-14 修回日期:2025-09-24 出版日期:2026-01-12 发布日期:2025-12-31
  • 通讯作者: 宋利 E-mail:songli040429@163.com
  • 基金资助:
    广东省医学科学技术研究基金项目(A2024441)； 广东省卫济医学发展基金会科研基金(K-20240105， K-20240110)

Effects of different urokinase thrombolysis methods on patency of tunneled-cuffed central venous catheters

WANG Fang-yuan, SONG Li, YIN Yan, XU Qing-xiu, CUI Dong-mei, ZHAO Li-yan, ZHOU Qing-hua, LIAO Jun-jie, CHEN Cheng, HU Yu-hang, HUANG Xin, FENG Zhong-lin   

  1. Department of Nephrology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, China
  • Received:2025-05-14 Revised:2025-09-24 Online:2026-01-12 Published:2025-12-31
  • Contact: 510080 广州，1南方医科大学附属广东省人民医院(广东省医学科学院)肾内科 E-mail:songli040429@163.com

摘要： 目的  探讨尿激酶不同溶栓方式对带隧道带涤纶套中心静脉导管(Tunneled-cuffed catheters,TCC)4年通畅率的影响。 方法  回顾性分析2021年6月─2024年5月广东省人民医院血液净化中心96例使用TCC行维持性透析患者的临床资料。根据TCC首次出现流量不足或栓塞时采用尿激酶溶栓方式分为封管溶栓组和上机前静推溶栓组。封管溶栓组：每侧导管使用生理盐水1 ml+尿激酶    125 000 IU+肝素钠1 ml(6250单位)配置，按管腔容量进行封管。上机前静推溶栓组：每侧导管使用生理盐水10 ml+尿激酶125 000 IU，透析前30～60 min使用恒速泵匀速泵入。观察2组患者TCC 4年的次级通畅率。 结果  共收集96例透析患者TCC尿激酶溶栓数据，上机前静推溶栓组11例次(14.5%)，封管溶栓组85例次(85.5%)。COX单因素Kaplan-Meier生存分析显示2组患者的TCC4年次级通畅率无统计学差异(HR=0.333，95% CI:0.044～2.530，P=0.239)。上机前静推溶栓组患者TCC第1、2、3、4年次级通畅率分别为90.9%，72.7%，54.5%，27.3%；封管溶栓组患者TCC第1、2、3、4年次级通畅率分别为64.7%，42.4%，22.4%，15.3%。 结论  封管溶栓组和上机前静推溶栓组次级通畅率无显著差异，生存分析曲线图显示生理盐水10 ml+尿激酶125 000 IU上机前静推溶栓方法有提高TCC次级通畅率的趋势，可能样本量不足组间差异不显著，需要今后前瞻性研究进一步验证本假设。

关键词: 带隧道带涤纶套中心静脉导管, 尿激酶溶栓, 尿激酶封管, 次级通畅率

Abstract: Objective  To explore the effects of different urokinase thrombolysis methods on the four-year patency rate of tunneled-cuffed catheters (TCC).  Methods  Clinical data of the 96 patients undergoing maintenance hemodialysis using TCC in the Blood Purification Center of Guangdong Provincial People's Hospital from June 2021 to May 2024 were retrospectively analyzed. According to the method of urokinase thrombolysis therapy when the patients first showed insufficient flow or embolism in TCC, they were divided into two groups: the lock-tube thrombolysis group and the pre-hemodialysis intravenous bolus thrombolysis group. In the lock-tube thrombolysis group, each side of the catheter was configured with 1 ml of normal saline + 125,000 units of urokinase + 1 ml (6,250 units) of heparin sodium, and locked according to the lumen volume. In the pre-hemodialysis intravenous bolus thrombolysis group, each side of the catheter was treated with 10 ml of normal saline + 125,000 units of urokinase, and pumped in at a constant speed of 30-60 minutes with a constant speed pump before hemodialysis. The four-year secondary patency rate of TCC was observed in the two groups.  Results  We collected the data of urokinase thrombolysis therapies for TCC in 96 patients, including 11 cases (14.5%) in the pre-hemodialysis intravenous bolus thrombolysis group and 85 cases (85.5%) in the lock-tube thrombolysis group. COX univariate Kaplan-Meier survival analysis showed that there was no statistically significant difference in the four-year secondary patency rate of TCC between the two groups (HR=0.333, 95% CI: 0.044～2.530, P=0.239). The one-year, two-year, three-year, and four-year secondary patency rates of TCC were 90.9%, 72.7%, 54.5%, and 27.3% respectively in the pre-hemodialysis intravenous bolus thrombolysis group, and were 64.7%, 42.4%, 22.4%, and 15.3% respectively in the lock-tube thrombolysis group.  Conclusion  There is no significant difference in the secondary patency rate between the lock-tube thrombolysis group and the pre-hemodialysis intravenous bolus thrombolysis group. Survival curve analysis shows that the pre-hemodialysis intravenous bolus thrombolysis method using 10 ml of normal saline+125,000 units of urokinase has a tendency of better secondary patency rate of TCC, but no statistical significance existed between the two groups probably due to insufficient sample size. Further verification of this hypothesis requires prospective research in the future.

Key words: Tunneled-cuffed central venous catheter, Urokinase thrombolysis, Urokinase lock-tube, Secondary patency rate

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