阿司匹林和氯吡格雷预防长期性中心静脉导管功能不良的临床研究

A Clinical Study of Aspirin and Clopidogrel for the Prevention of Late Malfunction in Tunneled Cuffed Hemodialysis Catheters

目的探讨阿司匹林和氯吡格雷预防长期性中心静脉导管功能不良的效果。方法将78例采用长期中心静脉导管的血透患者随机分为对照组(A组),阿司匹林组(B组)、氯吡格雷组(C组)。在用常规肝素封管基础上,B组服用阿司匹林100mg/d,C组服用氯吡格雷75mg/d。观察6个月后的导管动脉端静脉端功能情况、应用尿激酶干预情况、凝血指标的变化、药物副作用。结果 78例患者中,有6例因心脑血管疾病死亡退出研究,72例患者完成研究,导管动脉端功能不良发生率较静脉端高。分别为3.79%、1.45%、1.42%(B组和C组间P>0.05,B、C组和A组比较P<0.05):各组发生导管功能不良后用尿激酶封管,尿激酶首次干预时间A、B、C组分别为(30±21.1)d、(68±45.7)d、(65±39.6)d(B组和C组间P>0.05,B、C组和A组比较P<0.05):治疗组的尿激酶干预次数减少(P<0.05);治疗组比对照组的PT和APTT延长(P<0.05);治疗组无严重副作用发生。结论阿司匹林和氯吡格雷对于预防长期性中心静脉导管功能不良有一定疗效。

Objective To investigate the clinical effect of clopidogrel and aspirin in preventing late malfunction in tunneled cuffed hemodialysis catheters. Methods 78 hemodialysis patients with tunneled cuffed hemodialysis catheters were randomly divided into control group（A group）, aspirin group（B group） and colpidogrel group（C group）. All the groups were given heparin for sealing the catheter conventionally. In addition, B group was given aspirin 100mg/d and C group was given colpidogrel 75mg/d. Transcatheter arterial and venous end function, urokinase intervention, the changes of blood clotting index and side effects of the 3 groups were compared after 6 months. Results Of the 78 patients, 6 patients died of cardiovascular and cerebrovascular diseases and dropped out the study, the remaining 72 patients completed the study. Of the 72 patients, the incidence of transcatheter arterial end dysfunction was higher than venous end dysfunction. The incidence of transcatheter arterial end dysfunction of A group, B group and C group was 3.79%, 1.45% and 1.42%, respectively.（P 0.05,Compared B and C group; P 0.05,Compared B,C group with A group） Urokinase was used to seal the tube after catheter dysfunction occurred in each group. The days of first intervention with the urokinase of A, B, C group were（30卤21.1）d,（68卤45.7）d and（65卤39.6）d, respectively.（P0.05,Compared B and C group; P0.05,Compared B,C group with A group）The urokinase intervention times of B group and C group were less than those of A group with statistically significant difference（P0.05）. PT and APTT of B group and C group were longer than those of A group with statistically significant difference（P0.05）. And no serious side effects were found in B group and C group. Conclusion Aspirin and clopidogrel have certain curative effect on the prevention of late malfunction in tunneled cuffed hemodialysis catheters.