维持性血液透析患者采用不同抗凝剂封存Cuff导管的临床对照观察

The comparing study of sodium citrate and heparin in locking central vein hemodialysis catheter

目的:观察在长期带Cuff中心静脉导管患者封管时枸橼酸钠与肝素钠的有效性和安全性等疗效。方法:选择2011年6月至2012年12月期间于四川大学华西医院行长期带Cuff颈内静脉导管的透析患者,收集患者的一般临床资料、导管相关性感染(CRIs)和导管内血栓等情况。结果:研究收集97例患者,平均年龄54.9±14.5岁。肝素组患者中出现CRIs的例数明显多于枸橼酸钠组(2.49 vs 1.01/1 000导管日);在需使用尿激酶封管溶栓的患者中,枸橼酸钠组高于肝素钠组且有统计学差异(P<0.05)。结论:与肝素钠相比,枸橼酸钠用于Cuff中心静脉导管封管时可减少CRIs的发生,同时可能升高其导管内血栓形成风险。

Objective：To observe the long-term efficacy and safety of citrate and heparin in locking central venous hemodialysis catheter. Methodology：during June 2011 to December 2012, in a cohort of ninety seven hemodialysis patients with cuffed catheter in right jugular vein were enrolled into this study. According to the way of locking central vein hemodialysis catheter, they were divided into heparin group （5% heparin, n= 55） and sodium citrate group （4% sodium citrate, n = 42）o The catheter-related infections （CRIs）, side effects and catheter patency was accessed and compared between two groups. Results ： CRIs were higher significantly in heparin group than that in sodium citrate group （2.49 vs 1.01/ 1000 catheter-day） ; but patients in sodium citrate group had a lower catheter patency rate than those in heparin group （P〈0.05）. Conclusion：4% sodium citrate would be effective in lowing the occurrence of CRIs, but may be increase the risk of catheter thrombosis compared with 5% heparin.