三种不同浓度肝素封管液对血液透析患者颈内静脉留置导管并发症的影响

Impact of three different concentration of heparin tube -sealing solution on the jugular vein integrated catheter in hemodialysis patients

目的：观察并探讨三种不同浓度肝素封管液对血液透析（Hemodialysis，HD）颈内静脉留置导管患者并发症影响。方法选择接受治疗的血液透析患者96例，患者按照随机数字法分为 A 组、B 组、C 组，各32例。A 组为30 mg 肝素钠、B 组为40 mg 肝素钠、C 组为60 mg 肝素钠。评价三组患者症状改善程度以及并发症情况。结果三组导管留置手术后渗血或皮下血肿、导管位置不良、心律失常、空气栓塞例数分别为：A 组10例、11例、8例、5例；B 组9例、8例、9例、4例；C 组2例、1例、1例、0例。C 组与 A 组、B 组相比，并发症明显减少，差异均有统计学意义（χ^2＝6．667、10．42、4．706和5．450、4．706、7．680，均 P ＜0．05）；B 组与 A 组比，并发症接近，差异均无统计学意义（χ^2＝0．077、0．693、0．082、0．000，均 P ＞0．05）。三组患者感染和血栓情况例数为：A 组10例、8例；B 组9例、8例；C 组1例、1例。C 组与 A 组、B 组相比，感染和血栓明显减少，差异均有统计学意义（χ^2＝7．680、4．706，均 P ＜0．05）；B 组与 A 组比，感染和血栓接近，差异均无统计学意义（χ^2＝0．077、0．000，均 P ＞0．05）。结论对 HD 患者实施60 mg 的肝素钠生理盐水溶液进行封管有利于患者症状的改善，且减少了并发症的发生，值得在临床上进一步推广。

Objective To observe the impact of three different concentration heparin tube -sealing solution on the jugular vein integrated catheter in hemodialysis（HD）patients.Methods 96 HD patients were selected and divided into three groups according to different treatments.Each group had 32 cases.Patients in A,B and C group received heparin sodium 30mg,40mg,60mg respectively.The degree of symptoms improvement and the complications in the three groups were evaluated.Results For bleeding,catheter position adverse,arrhythmia,air embolism, A group had 10 cases,11 cases,8 cases,5 cases;B group had 9 cases,8 cases,9 cases,4 cases;C group had 2 cases, 1 case,1 case,0 case.Compared with B group and A group,C group had lower complication,the difference was statis-tically significant（χ^2 =6.667,10.42,4.706 and 5.450,4.706,7.680,all P 〈0.05 ）.Compared with A group, B group had no statistically significant （χ^2 =0.077,0.693,0.082,0.000,all P 〉0.05）;For the infection and throm-bosis,A group had 10 cases,8 cases;B group had 9 cases,8 cases;C group had 1 case,1 case.Compared with B group and A group,C group had lower complication,the difference was statistically significant （χ^2 =7.680,4.706,all P 〈0 .0 5 ）.Compared with A group ,B group had no statistically significant （χ^2 =0.077,0.000,all P 〉0.05 ）.Conclusion Treatment with 60mg heparin saline solution for HD patients will help to improve symptoms in patients, and decrease complications,thus it is worth for further promotion in clinical practice.