枸橼酸钠与肝素钠应用于血液透析患者封存Cuff导管的安全性和有效性对照研究

Comparative study of the safety and efficacy of sodium citrate and heparin for cuff tube sealing of patients with hemodialysis

目的对比枸橼酸钠与肝素钠应用于血液透析患者封存Cuff导管的有效性和安全性。方法共纳入70例患者,随机分为2组,分别采用4%枸橼酸钠及5%肝素钠封管,记录并统计封管后的不良反应,封管前后的凝血指标、血Ca^(2+),导管功能不良、导管相关性感染(CRIs)及导管内血栓等情况。结果两组在封管后无明显不良反应;至研究终点时枸橼酸钠组出现皮下出血2例(5.56%),肝素钠组为8例(20.51%),差异有统计学意义(P<0.05)。两组封管前PT、APTT、PLT比较差异无统计学意义(P>0.05),封管后,肝素钠组PT、APTT均显著延长,PLT显著降低,与枸橼酸钠组比较差异有统计学意义(P<0.05);两组封管前后血清Ca^(2+)均无显著变化(P>0.05)。枸橼酸钠组导管内抽吸出血栓例次数明显多于肝素钠组(P<0.05),两组血流量比较差异无统计学意义(P>0.05),两组导管功能不良发生率及导管交换或去除次数比较差异无统计学意义(P>0.05)。结论枸橼酸钠封存Cuff导管可达到与肝素钠类似的抗凝效果,并可明显降低出血倾向,还可一定程度降低CRIs的发生。

Objective To compare the efficacy and safety of sodium citrate and heparin for cuff tube sealing of patients with hemodialysis. Methods Totally 70 patients were randomly divided into two groups. Patients in the two groups used 4% sodium citrate or 5% heparin to seal tube. The adverse reactions after tube sealing, the coagulation, blood Ca2 ~ before and after the tube sealing, adverse catheter function, catheter-related infections （ CRIs ） and inner catheter thrombus were recorded. Results The two groups showed no significant adverse reactions after tube sealing ; to the end of the study, 2 patients （5.56%） of sodium citrate group had subcutaneous hemorrhage, and 8 cases （20. 51% ） of the heparin group had bleeding, the difference being statistically significant （ P 〈 0. 05 ）. The PT, APTT and PLT of the two groups showed no significant difference before tube sealing （ P 〉 0.05 ） ; after tube sealing, the PT and APTT of the heparin group were significantly prolonged, and the PLT was decreased significantly compared with the sodium citrate group, the difference being statistically significant （P 〈 0. 05 ）. The serum Ca2 ＋ of the two groups be- fore and after tube sealing did not change significantly （ P 〉 0. 05 ）. The number of cases of thrombosis on the sodium citrate group was significantly higher than the heparin group （ P 〈 0. 05 ）, but the blood flow of the two groups had no significant difference （ P 〉 0. 05 ） ; the incidence of adverse catheter function and the number of catheter exchange or re- moval of the two groups had no significant difference （ P 〉 0.05 ）. Conclusion Sodium citrate used in cuff tube seal- ing can achieve similar anticoagulant effects of heparin and reduce the bleeding tendency, besides, it can reduce the inci- dence of CRIs to a certain extent.