中国血液净化

中国血液净化 ›› 2018, Vol. 17 ›› Issue (08): 553-555.doi: 10.3969/j.issn.1671-4091.2018.08.011

• 血管通路 • 上一篇    下一篇

两种尿激酶溶栓方法治疗半永久性带涤纶套深静脉导管血栓的疗效观察

熊慧1,叶君红1   

  1. 1中国人民解放军第94医院肾内科
  • 收稿日期:2018-04-27 修回日期:2018-07-08 出版日期:2018-08-12 发布日期:2018-08-12

The two methods of urokinase thrombolysis therapy for the treatment of thromboses in the polyester-sheathed catheters semi- permanently indwelling in deep veins

  • Received:2018-04-27 Revised:2018-07-08 Online:2018-08-12 Published:2018-08-12

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摘要： 【摘要】目的观察2 种尿激酶(urokinase,UK)溶栓治疗半永久性带涤纶套深静脉导管血栓的疗效。方法选择2012 年11 月～2017 年4 月使用半永久性带涤纶套深静脉导管发生血栓的患者42 例，按照随机数字表法随机分为2 组，每组21 例。A 组采用微量泵持续泵入UK 8h，泵完正压封管，每日1 次；B组使用负压抽吸管腔后，利用虹吸原理吸入UK 溶栓，保留30mim，观察2 组溶栓成功率，透析血流量及有无并发症。结果2 组患者在溶栓结束后溶栓成功率(85.714%比95.238%，χ2=0.276,P=0.599)及透析时平均血流量[(239.014±32.123)ml/min 比(244.663±23.834)ml/min,t=0.647，P=0.521]比较差异无统计学意义；治疗1 个月后2 组患者溶栓成功率(52.380%比80.952%，χ2=3.857,P=0.049)及透析时平均血流量[(213.913±49.801)ml/min 比(243.262±39.652)ml/min,t=2.113，P =0.041]，比较差异有统计学意义；A 组患者在溶栓治疗后与治疗1 个月后血流量比较，差异无统计学意义(t=1.941，P=0.059)；B 组患者在溶栓治疗后与治疗1 个月后血流量比较，差异无统计学意义(t=0.139，P=0.890)，溶栓治疗的患者中A 组有1 例出现消化道出血，1 例局部出血；B 组无1 例出血。结论使用UK 负压溶栓治疗相较于UK
持续泵入+封管治疗半永久性带涤纶套深静脉导管血栓成功率高，治疗时间相对减少，降低药物的使用浓度，发生不良反应机率小，可以降低患者治疗费用，减轻患者痛苦，值得临床推荐。

关键词: 尿激酶溶栓, 半永久性带涤纶套深静脉导管, 血栓, 血液透析

Abstract: 【Abstract】Objective To observe the efficacy of the two methods of urokinase (UK) thrombolysis therapy for the treatment of thromboses in the polyester-sheathed catheters semi-permanently indwelling in deep veins. Methods A total of 42 patients with thromboses in the semi-permanent polyester-sheathed catheters in the period from November 2012 to April 2017 were enrolled in this study. They were randomly divided into two groups; group A used a micro-pump to continuously pump in UK for 8h everyday and kept the positive pressure when the outlet was sealed (n=21); group B used suction of the outlet to produce negative pressure in tubes, sucked UK into the tubes by siphon phenomenon, and kept UK in the tube for 30 minutes (n=21). The success rate of thrombolysis, average dialysis blood flow, and complications were compared between the two groups. Results There were no significant differences in the success rate of thrombolysis (85.714% vs. 95.238%;χ2=0.276,P=0.599) and the average blood flow (239.014±32.123 ml/min vs. 244.663±23.834 ml/min; t=0.647,P=0.521) after UK thrombolysis therapy between the 2 groups. After the treatments for one month, the success rate of thrombolysis (52.380% vs. 80.952%; χ2=3.857, P=0.049) and the average blood flow (213.913±49.801 ml/min vs. 243.262±39.652 ml/min; t=2.113, P=0.041) were significantly different between the two groups. There was no significant difference in the average blood flow before therapy and after the therapy for one month both in group A (t=1.941, P=0.059) and group B (t=0.139, P=0.890). Gastrointestinal bleeding in one case and local bleeding in one case were found in group A, but no hemorrhages occurred in group B. Conclusion For the treatment of thrombosis in the polyester-sheathed catheters semi-permanently indwelling in deep veins, UK thrombolysis therapy using negative pressure method was better than that using continuous injection and sealed the outlet at positive pressure in higher success rate of thrombolysis, shorter treatment period, less drug used, lower complication rate, few medical expenses, and less pain. Therefore it is worthwhile to be used clinically.

Key words: Urokinase, Thrombolysis, Polyester- sheathed catheter semi- permanently indwelling in deep vein, Thrombosis, Hemodialysis