尿激酶肝素混合封管在带涤纶套双腔透析导管中的应用效果观察

The application of urokinase and heparin mixture for sealing double-cavity catheters with Dacron sleeve

目的探讨分析尿激酶肝素混合封管在带涤纶套双腔透析导管中应用后的通畅性和安全性。方法将北京市普仁医院血液净化中心中心使用带涤纶套的双腔透析导管的患者共42例随机分为2组,研究组定期尿激酶与肝素混合液封管,对照组常规肝素封管,观察这2组患者12月内平均透析血流速、静脉压、导管功能良好例数、导管功能不良例数、更换导管例数,并监测患者的自发出血例次及凝血功能,以分析尿激酶封管在带涤纶套双腔透析导管中应用后的通畅性和安全性。结果尿激酶与肝素混合液封管后,导管血流量明显高于肝素封管组[观察6月时:(207.813±27.397)ml/min对(172.877±21.072)ml/min,t=4.632,P<0.001;观察12月时(177.885±23.421)ml/min对(151.836±28.817)ml/min,t=3.215,P=0.001],静脉压低于肝素封管组[观察6月时:(50.684±21.081)mm Hg对(66.211±18.669)mm Hg,=2.527,t P=0.008;观察12月时(76.919±32.543)mm Hg对(113.937±43.864)mm Hg,=t3.106,P=0.002]且导管功能好于肝素封管组(导管功能功能良好例数:18例对10例,χ~2=5.250,P=0.022;导管功能功能不良例数:2例对7例,χ~2=5.091,P=0.024;更换导管例数:1例对4例,χ~2=3.872,P=0.049)。两组患者均无自发性出血,且凝血功能检查无统计学差异[凝血酶原时间:(12.769±2.733)s对(12.580±1.346)s,t=0.284,P=0.389;国际标准化比值:1.032±0.139对1.021±0.154,t=0.243,P=0.405;凝血酶时间:(18.501±1.439)s对(17.903±0.895)s,t=1.617,P=0.057;纤维蛋白原:(2.696±0.928)g/L对(2.704±1.437)g/L,t=0.021,P=0.492;活化部分凝血酶原时间:(35.926±6.544)s对(34.406±7.327)s,t=0.709,P=0.241]。结论应用尿激酶肝素混合液封管,可降低带涤纶套双腔透析导管功能不良发生率,保证透析充分性,且对全身凝血功能无不良影响。

Objective To investigate the patency and safety of the urokinase and heparin mixture for sealing double-cavity catheters with Dacron sleeve. Method A total of 42 patients using double-cavity cath-eter with Dacron sleeve for hemodialysis and treated in the Blood Purification Center of Beijing PuRen Hospi-tal were recruited and divided into study group and control group. The dialysis catheter was sealed with uroki-nase and heparin mixture in study group and with heparin solution in control group. Average blood flow veloc-ity, venous pressure, numbers of patients with patent catheter, with catheter dysfunction and with catheter re-placement, and numbers of monitoring for spontaneous bleeding and coagulation function were observed to analyze the patency and safety of the double-cavity catheters with Dacron sleeve sealed with the mixture. Re-sults Blood flow volume （ml/min） in catheter was significantly higher in study group than in control group （207.813 ± 27.397 vs. 172.877 ± 21.072, t=4.632, P〈0.001 after the treatment for 6 months;177.885 ± 23.421 vs. 151.836±28.817, t=3.215, P=0.001 after the treatment for 12 months）. Venous pressure （mmHg） was lower in study group than in control group （50.684 ± 21.081 vs. 66.211 ± 18.669 mmHg, t=2.527, P=0.008 after the treatments for 6 months;76.919±32.543 vs. 113.937±43.864 mmHg, t=3.106, P=0.002 after the treatments for 12 months）. The number of patients with normal catheter function was more in study group than in control group （18 vs. 10,χ2=5.250, P=0.022 for number of patients with normal catheter function;2 vs. 7,χ2=5.091, P=0.024 for number of patients with abnormal catheter function）. The number of patients with replacement of di-alysis catheters was one in study group and 4 in control group （χ2=3.872, P=0.049）. There was no spontaneous bleeding and no significant difference in blood coagulation function in study group and control group （12.769± 2.733s vs. 12.580±1.346s, t=0.284, P=0.389 for prothrombin time;1.032±0.139 vs. 1.021±±0.154, t=0.243, P=0.405 for international standardized ratio;18.501 ± 1.439s vs. 17.903 ± 0.895s, t=1.617, P=0.057 for thrombin time;2.696±0.928g/L vs. 2.704±1.437g/L, t=0.021, P=0.492 for fibrinogen;35.926±6.544s vs. 34.406±7.327, t=0.709, P=0.241 for activated partial thrombin time）. Conclusion The urokinase and heparin mixture for sealing dialysis catheters can reduce the dysfunction of the double-cavity catheters with Dacron sleeve and en-sure dialysis adequacy without adverse effects on coagulation function of the whole body.