小剂量肝素盐水在深静脉导管早期堵塞中的临床应用及研究

The Clinical Application And Research of Small Dose of Heparin Saline in The Early Days of Deep Vein Catheter Jam

目的：观察不同浓度的肝素盐水在深静脉导管早期堵塞中的效果，以期达到减少肝素的用量和副作用，以小剂量肝素盐水达到最佳的疏通效果的目的。方法将2009年1月～2012年6月出现深静脉导管早期堵塞的维持血液透析患者随机分为观察组（肝素浓度为250 U/ml）和对照组（肝素浓度〉250 U/ml，其中包括500 U /ml和1250 U/ml）。比较2组疏通液对患者凝血4项（PT、APTT、TT、FIB）的影响，以及疏通的时间、导管疏通率、置管处渗血发生率等情况。结果20例再通成功，1例因死亡无法监测，2例堵塞大于2 h再通未成功。其中10例用1250 U/ml的肝素盐水进行再通，6例用500 U/ml的肝素盐水进行再通，7例用250 U/ml进行再通，早期堵塞的均能再通成功，再通率达100%。13例患者监测凝血指标，PT较再通前稍延长，APTT较前缩短，符合血栓前状态，观察组和对照组再通前后的疏通效果比较，差异具有统计学意义（P〈0.05），所有的患者均未出现出血等不良反应。结论2组均能达到导管早期再通的效果，肝素浓度越低对于存在高危出血风险的患者相对较安全。

Objective To compare the different concentrations of heparin saline observed in early deep venous catheter blockage effect, toreduce the dosage and side effects of heparin and low-dose heparin saline to achieve the best effect of dredge. Methods January 2009 to June 2012, deep the early venous catheter blockage the maintenance hemodialysis patients were randomly divided into the observaion groups（heparin concentration of 250 U/ml） and the control group（heparin concentration〉250 U/ml including 500 U/ml and 1250 U/ml）. 4 （PT, APTT, TT, FIB）were compared between the two groups dredge liquid on Coagulation and dredge, rate of catheter dredge, catheter at the bleeding incidence. Results 20 cases of recanalization success, one cases of death can not be monitored. Two cases clogging than 2 hours is not successful recanalization. Of which 10 cases with 1250 U/ml heparin saline recanalization, six cases of recanalization 500 U/ml liver saline, 7 patients with 250 U/ml recanalization early jams are longer-pass success, recanalization rate 100%. 13 patients with coagulation monitoring indicators, PT than recanalization slightly extended, APTT than before to shorten the line prothrombotic state, the observation group and the control group before and after the recanalization （P〈0.05）, all patients were not bleeding and other adverse reactions. Conclusion The two groups can reach the effect of early recanalization catheter, the lower the concentration of heparin is relatively safe for patients with high risk of bleeding exists.