摘要
目的:观察早期尿激酶封管在防治长期透析患者导管纤维蛋白鞘形成中的应用效果。方法:选取2021年2月—2022年2月期间我院血透室及肾内科进行规律血液透析治疗的患者46例,将患者随机分为两组,尿激酶组(23例)在首次透析治疗时即开始进行尿激酶封管治疗,而常规组(23例)在首次透析时仅先应用常规肝素进行封管治疗,在患者导管出现功能不良后才开始应用尿激酶封管再通导管。比较两组患者导管功能不良出现情况、治疗前后凝血功能指标水平变化情况、治疗期间导管血流量及静脉压改变情况及不良反应发生情况。结果:尿激酶组患者导管功能不良出现次数远低于常规组,且尿激酶组患者平均首次出现导管功能不良时间较常规组晚。透析6个月时,两组患者的APTT、TT以及Fib水平比较均无明显差异,但尿激酶组患者平均PT时间明显较常规组更长。透析1个月时两组患者的平均导管血流量及静脉压未见显著差异;透析3个月与6个月时,尿激酶组的平均血流量显著高于常规组,而静脉压显著低于常规组。尿激酶组及常规组患者均未出现需要停止治疗的严重不良反应,未见胃肠道出血、严重肝损伤等药物毒副反应。结论:在需长期置管行血液透析治疗的患者中采取早期尿激酶封管措施可较好的预防导管内纤维蛋白鞘的形成,延长导管的使用寿命,且安全性高。
Objective To observe the effect of early urokinase sealing in preventing the formation of catheter fibrin sheath in long-term hemodialysis patients.Methods From February 2021 to February 2022,46 patients were selected for regular hemodialysis treatment in the hemodialysis room and nephrology department of our hospital.The patients were divided into two groups.In the urokinase group,23 patients began to receive urokinase tube sealing treatment at the time of the first dialysis treatment,while in the conventional group,23 patients only received conventional heparin tube sealing treatment at the time of the first dialysis treatment,and urokinase therapy was started only after the patient's catheter was dysfunctional.The occurrence of catheter dysfunction,the change of coagulation function index before and after treatment,the change of catheter blood flow and venous pressure during treatment and the occurrence of adverse reactions were compared between the two groups.Results The occurrence of catheter dysfunction in the urokinase group was much lower than that in the conventional group,and the average time of the first occurrence of catheter dysfunction in the urokinase group was later than that in the conventional group.At 6 months of dialysis,there was no significant difference in APTT,TT and Fib levels between the two groups,but the average PT time of the urokinase group was significantly longer than that of the conventional group.There was no significant difference in the mean catheter blood flow and venous pressure between the two groups at 1 month of dialysis.At 3 and 6 months of dialysis,the average blood flow in the urokinase group was significantly higher than that in the conventional group,while the venous pressure was significantly lower than that in the conventional group.Neither urokinase group nor routine group had any serious adverse reactions that needed to stop treatment,no gastrointestinal bleeding,serious liver injury and other drug toxicity.Conclusion In patients who need long-term catheterization for hemodialysis treatment,early urokinase sealing measures can better prevent the formation of fibrin sheath in the catheter,prolong the service life of the catheter,and have high safety.
作者
梁雨
刘焕皓
麦海燕
黄钰
梁金月
LIANG Yu;LIU Huanhao;MAI Haiyan;HUANG Yu;LIANG Jinyue(The People's Hospital of Wuzhou,Wuzhou 543002,China)
出处
《湖南师范大学学报（医学版）》
2024年第1期85-89,共5页
Journal of Hunan Normal University(Medical Sciences)
基金
梧州市科技计划项目“早期尿激酶封管联合氯吡格雷对预防和治疗长期透析纤维蛋白鞘的相关性研究”(202002164)
关键词
长期透析
留置导管
纤维蛋白鞘
尿激酶封管
long-term hemodialysis
indwelling catheter
fibrin sheath
urokinase sealing
作者简介
通信作者:刘焕皓,E-mail:127349777@qq.com
