›› 2010, Vol. 9 ›› Issue (5): 265-268.

• 临床研究 • 上一篇    下一篇

尿激酶24小时停留封管溶栓治疗对颈内静脉留置双腔透析导管内血栓形成的疗效研究

薛志强 曾石养   

  1. 广州暨南大学附属第五医院(清远市人民医院)肾内科
  • 收稿日期:2009-12-08 修回日期:1900-01-01 出版日期:2010-05-12 发布日期:2010-05-12

Effects of urokinase 24 hours dwelling-lock thrombolysis treatment on thrombosis in double lumen catheter indwelling in internal jugular vein for dialysis

XUE Zhi-qiang, ZENG Shi-yang   

  1. Department of Nephrology, the fifth Affiliated Hospital of Ji Nan University (Qing Yuan People's Municipal Hospital) , Qingyuan 510000, China
  • Received:2009-12-08 Revised:1900-01-01 Online:2010-05-12 Published:2010-05-12

摘要:

【摘要】 目的 比较使用20 000 U/ml尿激酶注射液24 h停留封管溶栓治疗与美国肾脏病基金会肾脏病预后质量倡议(kidney disease outcomes quality initiative,K/DOQI)指南推荐溶栓治疗方案对颈内静脉留置双腔导管血栓形成的治疗效果。 方法 对88例于2003年8月至2008年12月在广州暨南大学附属第五医院因慢性肾衰竭使用临时性颈内静脉留置双腔导管进行血液透析治疗,临床诊断导管内血栓形成病例进行前瞻性随机对照临床研究,其中治疗组45例,对照组43例。治疗组使用20 000 U/ml尿激酶溶液24 h停留封管溶栓治疗,对照组使用美国肾脏病基金会K/DOQI指南推荐方案进行溶栓治疗。比较两种溶栓治疗方法对颈内静脉留置双腔导管血栓形成的治疗效果以及副作用。 结果 治疗组动脉端溶栓成功率81.3%,静脉端成功率100%,总成功率88.2%;对照组动脉端溶栓成功率87.5%,静脉端成功率94.7%,总成功率90.2%;两种溶栓疗法临床疗效差异无统计学意义(P>0.05)。溶栓治疗成功后,治疗组患者血栓复发率11.1%,对照组复发率15.2%,两组患者再次发生血栓形成的比例差异无统计学意义(P>0.05)。两种不同导管溶栓治疗方案对患者凝血功能无明显影响。 结论 20 000 U/ml尿激酶溶液停留封管24 h,可以有效治疗颈静脉留置双腔透析导管血栓形成并恢复导管功能。与K/DOQI指南推荐溶栓方法比较,其治疗成功率相似,但操作更为简便,且无明显副作用及治疗并发症。

关键词: 中心静脉导管, 血栓形成, 尿激酶, 溶栓, 血液透析

Abstract:

【Abstract】 Objective This single-center, open-label control clinical study was performed to test the effect of a dose (20000 IU/mL) urokinase 24 hours dwelling-lock thrombolysis technique to clear double lumen central venous catheters for dialysis and reestablish patency when occluded by thrombus. Safeties and efficacies of the new technique were compared with those of regimen recommended by K/DOQI guideline. Methods Adult dialysis patients with nontunneled double lumen central venous catheters occlusion were treated with 20000 IU/mL intracatheter urokinase 24 hours dwelling-lock thrombolysis technique(treatment group) or 5000 IU/mL urokinase instillations thrombolysis regimen recommended by K/DOQI guideline(control group). Lumen patency, side effects and cathether thrombus reoccurrence were assessed and compared between the two groups after the treatment. Results A total of 88 cases of non-tunneled double lumen central venous catheters occlusion were enrolled in the study during Aug 2003 and Dec 2008. 45 were in treatment group and 43 in control group. Overall, 20000 IU/mL urokinase 24 hours dwelling-lock thrombolysis technique successfully restored total catheter patency (all treated lumens) to 88.2% of catheter ocllusions (45 of 51). Patency was restored in 90.2% of devices (46 of 51) in 5000 IU/mL urokinase instillations group. Patency was restored equally in both group and no side effects were recorded in both treatments. Catheter occlusions reoccurrences were also equal in both groups. Conclusion The use of a new 20000 IU/mL intracatheter urokinase 24 hours dwelling-lock thrombolysis technique is simple, safe and effective for the restoration of patency to occluded dialysis nontunneled double lumen central venous catheters.

Key words: Thrombosis, Thrombolysis, Urokinase, Hemodialysis