浓氯化钠封管液在诱导期无肝素透析中的应用探讨

The study of concentrated sodium chloride sealing solution in heparin-free hemodialysis during the induction period

目的比较浓氯化钠（10％氯化钠，又称高张盐水）与传统封管液在诱导期透析患者无肝素透析后对出血风险的影响，探讨更合理的无肝素透析后中心静脉导管封管方案。方法将64例以中心静脉导管作为诱导期透析血管通路的无肝素透析患者按年份分为两组，对照组32例透析结束后使用1：3的肝素盐水（1562．5U／ml）封管液，观察组32例透析结束后使用浓氯化钠封管液。测定封管后2、4h凝血指标，监测出血情况、导管回抽通畅情况、感染情况等。结果对照组在封管后2h的凝血功能指标[血浆纤维蛋白原（FIB）、PT—INR]均超过观察组（P〈0．05），活化部分凝血活酶时间（APTT）、凝血酶时间（TT）、凝血酶原（PT）与观察组比较无统计学差异（P〉0．05）。观察组患者出血事件发生率少于对照组，差异有统计学意义（P〈0．01）。结论浓氯化钠封管液应用于以中心静脉导管作为诱导期透析血管通路的无肝素透析患者，能显著减少透析后的出血并发症，减轻病人经济负担，值得临床推广应用。

Objective To compare the effect of concentrated sodium chloride （10% sodium chloride, also known as hypertonic saline） and traditional sealing solution on the risk of hemorrhage after heparin-free hemodialysis （HFHD） during the induction period, and to probe more reasonable choice for central venous catheter （CVC） sealing solution after HFHD. Methods 64 patients undergoing HFHD with CVC as dialysis vascular access during the induction period were divided into two groups according to the time. 32 cases in control group were given 1：3 heparin saline （1562.5 U/ml） sealing solution after dialysis, while 32 cases in observation group were given concentrated sodium chloride sealing solution after dialysis. Detected coagulative function index 2, 4 hours after tube sealing, monitored bleeding, catheter withdrawing patency, infection, and other conditions. Results Coagulative function index [plasma fibrinogen （FIB）, PT-INR] of control group 2 hours after tube sealing were more than those of observation group （P〈0.05）, there were no statistically significant differences in activated partial thromboplastin time （APTT）, thrombin time （TT）, prothrombin （PT） between two groups （P〉0.05）. The rate of bleeding of observation group was lower than that of control group, with statistically significant difference（P〈0.01）. Conclusion Concentrated sodium chloride sealing solution applied in patients undergoing HFHD with CVC as dialysis vascular access during the induction period, can significantly reduce bleeding complications after dialysis, reduce the financial burden of patients, worthy of clinical application.