规律性微量泵入尿激酶溶栓治疗对维持性血液透析患者的效果

Effect of regular micro-pumped urokinase as a thrombolytic therapy on maintenance hemodialysis patients

目的探讨规律性微量泵入尿激酶溶栓治疗对维持性血液透析患者的效果。方法选取2015年12月~2017年3月在我院血液透析中心36例带绦纶套双腔导管且留置时间>3个月的维持性血液透析患者,按照随机抽签法分为观察组(微量泵入尿激酶溶栓治疗)和对照组(定时保留式尿激酶溶栓法治疗),每组18例。观察组使用尿激酶125 000 U/次+NS100 ml微量泵入,每2周1次,持续滴注1 h。对照组使用125 000 U/次+NS12 ml分3次进行推注封管溶栓治疗,每2周1次,每次1 h,两组均治疗3个月。比较两组患者治疗前后血流量、静脉压及KT/V值变化情况;记录两组患者cuff管血栓形成、导管感染及导管功能不良等反应情况。结果治疗后,观察组静脉压(68.0±30.5)mm Hg显著低于对照组(162.0±37.5)mm Hg,差异有统计学意义(P<0.05);观察组血流量、KT/V显著高于对照组,差异有统计学意义(P<0.05)。治疗后,观察组cuff管血栓形成、导管感染、导管抽吸不畅均低于对照组,差异有统计学意义(P<0.05);治疗后,两组患者出血发生率比较,差异无统计学意义(P>0.05)。结论规律性微量泵入尿激酶溶栓治疗,可有效地维持带cuff导管的功能,延长导管使用时间,提高透析效率,是一种安全有效的治疗手段。

Objective To investigate the effect of regular micro-pumped urokinase as a thrombolytic therapy on maintenance hemodialysis （MHD） patients.Methods From December 2015 to March 2017,36 MHD patients who were indwelled with dual-lumen catheter with a Dacron cuff for over 3 months in hemodialysis center in our hospital were selected.By random lot-drawing,they were evenly divided into observation group （micro-pumped urokinase as a thrombolytic therapy） and control group （retained urokinase at regular time as a thrombolytic therapy）,18 cases in each group In the observation group,micro-pumped urokinase （125 000 U each time ） and NS （100 ml） for one continuous hour of dripping,once every two weeks,while in the control group,urokinase （125 000 U each time） and NS （12 ml） were injected into a sealed tube for thrombolytic treatment at three times,one hour once,and once every two weeks.The courses of treatment lasted for 3 months.The blood flow volume,and the changes of venous pressure and KT/V before and after therapy were observed and compared in the two groups.The cuff tube thrombosis,tube infection,and catheter dysfunction were recorded in both groups.Results After therapy,the venous pressure in the observation group was （68.0±30.5） mmHg,much lower than that in the control group [（162.0±37.5） mmHg],with a statistical difference （P〈0.05）.The blood flow volume and value of KT/V in the observation group were both superior to those in the control group with statistical differences （P〈0.05）.After therapy,the cuff tube thrombosis,tube infection,and obstruction of catheter sucking were all lower than those in the control group with statistical differences （P〈0.05）.The incidence of hemorrhage was not displayed significance difference after therapy（P〉0.05）.Conclusion Regular micro-pumped urokinase as a thrombolytic therapy can effectively maintain the function of cuff catheter,prolong the use of catheter, and improve the efficiency of dialysis,which is a safe and effective therapeutic mode.