三种不同冲洗液在ICU动脉置管患者中的应用及对凝血功能的影响

Effects of different heparin-containing flushing solutions on the coagulation function of patients with arterial catheters in ICU

目的：探讨ICU危重症患者在低分子肝素抗凝治疗的同时将生理盐水冲洗液替代肝素冲洗液使用的可行性。方法将120例行桡动脉穿刺监测血压的患者随机分为3组，A组肝素冲洗液浓度为2．5 U／ml，B组肝素冲洗液浓度为1 U／ml，C组为生理盐水。置管期间每6 h进行一次导管通畅性监测试验。记录动脉堵管发生率、平均动脉置管时间、动脉穿刺点渗血发生率。分别于入院时、置管1天、置管3天、置管5天、置管7天、拔管时、拔管后3天、拔管后7天抽取动脉血4 ml，监测凝血功能。结果实验过程中，3组导管保持通畅。3组冲洗液在堵管发生率及置管天数上无显著差异（P＞0．05）。 A组患者穿刺点渗血明显高于其他两组，差异具有统计学意义（P＜0．05）。3组患者的凝血检测指标无显著性差异（P＞0．05）。结论生理盐水冲洗液可有效维护动脉导管的通畅性，并降低不良反应，值得临床推广应用。

Objective To investigate the application of saline flushing solution as a substitute of heparin -contai-ning flushing solution in critically ill patients in ICU during their low -molecular -weight heparin （ LMWH） therapy. Methods A total of 120 patients who underwent invasive arterial pressure monitoring were included into the current study .These patients were randomly divided into three groups , according to the flushing solutions used .Catheter patency was monitored every 6 hours.Then, arterial blood samples was drawn on admission , Days 1, 3, 5 and 7 of catheter placement, immediately after extubation , and 3 and 7 days after extubation to assess coagulation function .Results Catheter patency was maintained during the experiments .No statistical difference was found in the incidence of arterial blockage and the time of catheter placement different among these groups （P〉0.05）.However, capillary hemorrhage was more frequently observed at the arterial puncture sites of Group A than those in other group （P〈0.05）.There were no significant differences in coagulation indexes in all patients （P〉0.05）.Conclusion Saline flushing solution can ef-fectively guarantee catheter patency and reduce adverse reactions , which is worth of clinical practice .