间歇性血液透析中不同浓度肝素封管法的对比研究

Impact of heparin locking concentration on preventing temporary dialysis catheter dysfunction in intermittent haemodialysis patients

目的观察间歇性血液透析(IHD)患者深静脉置管不同浓度肝素封管的效果,探讨合适封管的肝素浓度。方法将108例维持血液透析患者随机分为3组,每组36例,封管液使用肝素钠和0.9%氯化钠配制,肝素浓度分别为A组1 250U/mL,B组3 125 U/mL,C组5 208 U/mL;监测凝血象、观察3种肝素溶液封管后患者出血并发症、导管堵塞率、导管留置时长、导管相关感染发生率等。结果 3组凝血象指标改变不显著(P>0.05);与A组相比肝素浓度高的两组血透置管留置时间较长,管腔堵塞、导管相关感染(CRI)发生率低,差异均有统计学意义,且C组好于B组。结论高浓度肝素封管可延长单针双腔深静脉透析管使用寿命,且不增加患者出血的风险,可成为IHD患者维持临时血管通路理想的封管方法。

Objective To compare the effectiveness of three heparin concentrations in preventing catheter malfunction,and to investigate the reasonable concentration of heparin-locking solution.Methods One hundred and eight sustaining haemodialysis patients were randomly divided into three groups,each with 36 patients.The heparin-locking solution was made of heparin sodium and 0.9% sodium chloride solution.The different concentration of heparin-locking solution was used to fill each lumen of the hemodialysis central venous catheter： group A（1 250 U/mL）,group B（3 125 U/mL）,group C（5 208 U/mL）.Blood coagulogram,the venipuncture export bleeding or other bleedings,catheter blocking because of intracatheter thrombosis,the period of dialysis catheter in good function and the rate of catheter-related infections（CRI） were observed.Results There was no significant difference on blood coagulogram and bleeding（P〈0.05）.The incidence of catheter blocking,CRI in Group B and group C was significant fewer than group A,and the time of using the catheter in Group B and group C was longer than group A.Moreover,the results of group C were better than those of group B.Conclusion The life of catheter can be prolonged if higher concentration heparin-locking solution is used to fill each lumen of the hemodialysis catheter.The risk of bleeding cases will not increase at all.Higher concentration heparin-locking solution is the reasonable way if dialysis catheter keeps good function.