乙醇封管在维持性血液透析长期留置导管患者中的应用研究

Application of ethanol locks in maintenance hemodialysis patients with long-term catheter indwelling

目的研究70%乙醇封管对维持性血液透析长期留置导管患者导管相关性菌血症、导管功能不良发生率的影响,为临床治疗提供参考。方法选择长期留置导管的维持性血透患者,采用随机分组对照研究,试验组采用70%乙醇每周1次封管,其余采用标准肝素溶液封管,对照组全部使用标准肝素封管,治疗24周,观察导管相关性菌血症、导管功能不良的发生率及其他不良反应。结果试验组导管相关性菌血症发生率为5.0%,对照组导管相关性菌血症发生率为35.0%,两组间比较,差异有统计学意义(P<0.05),而导管功能不良的发生率、肝脏转氨酶在两组间差异均无统计学意义。结论与标准肝素封管相比,每周1次的70%乙醇封管能有效防止导管相关性菌血症的发生,不增加导管功能不良的发生率,安全性好。

OBJECTIVE To determine whether weekly instillation of 70% ethanol prevents the catheter-related bacteremia and influences the incidence of the dysfunction of catheter so as to guide the clinical treatment. METHODS A randomized, prospective, controlled study was undertaken. Hemodialysis patients were randomly assigned to receive 70 % ethanol into each lumen of the catheter once a week and standard heparin locks for other dialysis days, or to receive heparin locks only for 6-month periods. The incidence rates of the catheter-related bacteraemia （CRB） ,the catheter dysfunction, and other adverse reactions were recorded. RESULTS The incidence rate of CRBs was 5.0% in the test group and 35.0% in the control group, the difference between the two groups was statistically significant （P〈0. 05）, however, the difference in neither the incidence rate of the catheter dysfunction nor the liver transaminase between the two groups was not statistically significant. CONCLUSION As compare with the heparin catheter locks, 70 % ethanol lock used for once a week can effectively prevent the CRBs without increasing the incidence of the catheter dysfunction and is safer.