预防性尿激酶溶栓在血液透析长期导管中的应用效果

Application of Prophylactic Urokinase Thrombolysis in Long-term Catheterization of Hemodialysis

目的探讨预防性尿激酶定期、交替溶栓在血液透析长期导管中的应用效果及护理方法。方法选取我院2015年9月至2016年2月血液净化中心使用长期导管进行维持性血液透析,留置时间均大于3个月,并且发生不同程度的导管血栓形成患者30例,随机分为观察组和对照组,各15例。对照组按常规封管方法护理,观察组常规封管护理的同时每月尿激酶持续微泵溶栓1次,于透析前1 d进行,尿激酶溶栓每2周进行1次,交替进行,连续观察6个月。每个月月末测定两组尿素的清除指数(Kt/V)、记录两组患者透析时平均血流速度(QB)、泵前平均动脉压(PA)、静脉压(PV)、上机前导管完全堵塞或不完全堵塞的发生例次、透析过程中流量不佳需要干预的例次、置管口渗血发生例次及滤器凝血情况。结果观察组和对照组在尿素清除指数、平均血液流速、泵前动脉压、静脉压、患者上机前导管发生完全都塞、不完全都塞、治疗过程中需要护理干预的发生例次、滤器发生凝血情况差异均具有统计学意义(P<0.05),而在置管口渗血的发生例次上两组差异无统计学意义(P>0.05)。所有患者在溶栓后无诉不适。结论预防性尿激酶定期、交替溶栓治疗可以有效地维持永久性双腔透析导管功能,延长导管使用寿命,提高透析效率。

Objective To investigate the effect and nursing methods of prophylactic urokinase on the long-term catheterization of hemodialysis. Methods From September 2015 to February 2016,30 patients with different degrees of catheter thrombosis were randomly divided into two groups ： control group （ n = 30） , control group（n = 30）, control group（ n = Group and control group, 15 cases each. The patients in the control group were treated with conventional sealing method. The patients in the observation group were treated with routine urokinase micro-pump once a month, and the patients were treated with routine urokinase thrombolysis once every 2 weeks. 6 months of observation. The clearance index（ Kt / V） of urea was measured at the end of each month The mean blood flow velocity （ QB ）, mean arterial pressure （ PA）, venous pressure （ PV ）, total occlusion or partial occlusion were recorded in two groups. The flow rate during dialysis was poor Need to intervene in the cases ,the mouth of the mouth of bleeding cases and filter coagulation cases. Results The observation group and the control group in the urea clearance index, mean blood flow velocity, pump pressure, venous pressure, the patient before the catheter completely occluded, not completely plug, the need for nursing intervention in the course of the occurrence of the filter occurs （ P 〈 0.05 ）, but there was no significant difference between the two groups（P 〉0. 05）. There is no significant difference in blood coagulation between the two groups （P 〉 0. 05 ）. All patients had no complaints after thrombolysis. Conclusion The prophylactic urokinase treatment can effectively maintain the function of permanent double-chamber dialysis catheter, prolong the life of catheter and improve the efficiency of dialysis.