重组组织纤溶酶原激活剂预防带隧道带涤纶套导管阻塞的效果观察

The clinical effect of recombinant tissue plasminogen activator on prevention of thrombokinesis in tunneled cuffed catheter

目的探讨定期应用重组组织纤溶酶原激活剂（recombinant tissue plasminogen activator,rt-PA）预防带隧道带涤纶套导管（tunneled cuffed catheter,TCC）阻塞的效果。方法将62例维持性血液透析患者随机分为：常规组、尿激酶组和rt-PA组。3组间进行两两比较,对比分析每次透析前抽吸不畅发生率、透析中需干预事件的发生率、透析血流量、透析静脉压、并发症（出血、感染）情况等。结果在透析前抽吸不畅发生率、透析中需干预事件发生率、透析静脉压方面,rt-PA组低于尿激酶组[分别为5.1%比10.7%,χ~2=58.643,P=0.000;5.8%比11.0%,χ~2=48.027,P=0.000;（113.0±14.1）mm Hg比（123.0±14.4）mm Hg,=3.154,q P=0.037]和常规组[分别为5.1%比13.7%,χ~2=115.387,P=0.000;5.8%比17.8%,χ~2=187.411,P=0.000;（113.0±14.1）mm Hg比（135.2±15.1）mm Hg,q=6.854,P=0.005],尿激酶组亦分别低于常规组（P〈0.05）。rt-PA组透析血流量大于尿激酶组[（248.1±14.9）ml/min比（239.1±14.2）ml/min,q=2.906,P=0.042]和常规组[（248.1±14.9）ml/min比（227.9±13.4）ml/min,q=6.378,P=0.006],尿激酶组大于常规组（q=3.508,P=0.032）。3组间在发生出血（χ~2=0.233,P=0.890）、感染并发症（χ~2=1.541,P=0.463）方面差异无统计学意义。结论在应用肝素常规封管的基础上定期给予rt-PA封管,可以安全、有效地预防TCC阻塞,增加透析血流量。

Objective To explore the clinical effect of recombinant tissue plasminogen activator（rt-PA）on the prevention of thrombokinesis in tunneled cuffed catheter（TCC）. Methods A total of 62 cases of maintenance hemodialysis patients were randomly divided into control group, urokinase group, and rt- PA group. The difficulties of blood access before dialysis, the intervention rate during dialysis, blood flow volume, venous pressure, and other complications were compared among the 3 groups. Results The difficulties of blood access before dialysis, the intervention rate during dialysis, and venous pressure were lower in rt-PA group than in urokinase group（5.1% vs. 10.7%, χ~2=58.643, P=0.000 for difficulties of blood access before dialysis; 5.8% vs. 11.0%, χ~2=48.027, P=0.000 for intervention rate during dialysis; 113.0±14.1 mm Hg vs. 123.0±14.4 mm Hg, q=3.154, P=0.037 for venous pressure） and control group（5.1% vs. 13.7%, χ~2=115.387, P=0.000 for difficulties of blood access before dialysis; 5.8% vs. 17.8%, χ~2=187.411, P=0.000 for intervention rate during dialysis; 113.0±14.1 mm Hg vs. 135.2±15.1 mm Hg, q=6.854, P=0.005 for venous pressure）. These parameters were also lower in urokinase group than in control group（P〈0.05）. Blood flow volume was higher in rtPA group than in urokinase group（248.1±14.9 ml/min vs. 239.1±14.2 ml/min, q=2.906, P=0.042） and control group（248.1±14.9 ml/min vs. 227.9±13.4 ml/min, q=6.378, P=0.006）, and was higher in urokinase group than in control group（q=3.508, P〈0.05）. The rates of bleeding and infection were similar among the 3 groups（χ~2=0.233, P=0.890 for bleeding; χ~2=1.541, P=0.463 for infection）. Conclusion In addition to heparin, regular use of rt-PA for blocking TCC can safely and effectively prevent thrombokinesis in TCC and increase dialysis blood volume.