半永久性双腔导管血栓预防的相关护理探究

Nursing exploration on preventing thrombosis in semipermanent double channel catheter

目的观察尿激酶两种不同的应用方法针对血液透析用半永久性双腔导管尖部血栓及纤维蛋白鞘的预防及治疗方法的效果观察。方法选择河北医科大学第三医院血液净化中心2010年1月~12月行半永久性双腔导管置管血液透析患者20例,其中男性11例,女性9例;年龄45～82岁,平均年龄56岁。随机分为2组。共行血液透析2210例次。观察组采用100 kU尿激酶加入100 mL 0.9%NaCl溶液缓慢滴注,对照组采用尿激酶肝素混合液封管,比较透析前导管抽吸不畅事件及透析过程中护理干预情况。结果观察组透析前导管抽吸不畅事件[28例次（2.5%）]及透析过程中护理干预的次数[51例次（4.5%）]明显少于对照组[110例次（10.2%）,221例次（20.5%）],观察组在透析过程中血流量[（241.6±55.2）mL/min]情况明显好于对照组[（208.0±52.7）mL/min]。结论尿激酶预防滴注法对于半永久性双腔导管尖部血栓及纤维蛋白鞘的治疗效果明显优于尿激酶肝素混合液封管法。

Objective To compare the efficacy of two applied methods of urokinase in the prevention and treatment of thrombosis and fibrin sheathe formation in the spike of semipermanent dual-lumen dialysis catheter in hemodialysis.Methods A total of 20 cases of uremia patients were enrolled,male 11,female 9;aged 45-82 years old,mean aged 56 years old.They were randomly divided into 2 groups,the observation group and control group,each 10 cases,and performed hemodialysis 2 210 case-times.The observation group was treated with urokinase 100 000 unit in normal saline 100 mL intravenously,while the control group with urokinase and heparin impregnation of catheter.The dialysis catheter obstructed events in pre-dialysis and nursing intervention times in dialysis were compared.Results The catheter obstructed events[28 case-times（2.5 %）] in pre-dialysis and nursing intervention times[51 case-times（4.5 %）] during dialysis in observation group was significantly fewer than that of control group[110 case-times（10.2 %）,221 case-times（20.5 %）].The blood flow in observation group[（241.6 ± 55.2） mL/min] was remarkably better than that of control group[（208.0 ± 52.7） mL/min].Conclusion It is demonstrated that the treatment effect on thrombus of tip and fibrin scabbard in semipermanent double channel catheter with the method of preventive dripping urokinase is much more excellent than tube sealing with urokinase and heparin.