尿激酶导管内泵入治疗带隧道和带涤纶套的导管血栓形成的疗效

Curative effect of urokinase intraductal pump on catheter thrombosis with tunnel and polyester sleeve

目的探讨尿激酶导管内泵入治疗带隧道和带涤纶套的导管血栓形成的疗效。方法选取2015年7月至2016年10月在透析中心行维持性血液透析,出现带隧道带涤纶套的长期透析导管功能不良,行尿激酶导管内溶栓无效者共16例次。采取尿激酶泵入溶栓治疗。25万U尿激酶+0.9%Na Cl溶液100 ml,分别以10 ml/h的速度从导管的动静脉端同时泵入,10 ml/h,共5 h。观察溶栓前和溶栓后的血流量、管路动脉压和管路静脉压的情况。结果经尿激酶全身溶栓后,患者导管通畅率为100%。血流量[(271.25±10.25)ml/min vs(93.13±22.72)ml/min]、管路动脉压[(11.63±2.91)mm Hg vs(45.08±11.27)mm Hg]、管路静脉压[(13.01±3.25)mm Hg vs(5.64±1.41)mm Hg]较溶栓前均显著改善(P<0.01)。符合导管通畅评价标准。溶栓前后患者的凝血酶原时间、部分凝血活酶时间、丙氨酸氨基转移酶、天冬氨酸氨基转移酶均无明显异常改变(P>0.05)。结论尿激酶导管内泵入治疗带隧道和带涤纶套的导管血栓形成有较好的效果,且安全性较好。

Objective To investigate the effect of intraduetal infusion of urokinase （UK） in the treatment of catheter thrombosis with tunnel and polyester sleeve. Methods Sixteen patients with ineffective intraductal UK thrombolysis from July 2015 to October 2016 were selected, and UK infusion pump therapy （ 250 thousand U plus 100 ml normal saline pumped into catheter at 10 ml/h speed from the catheter＇s arteriovenous ends at the same time） were given for 5 hours. The blood flow, arterial pressure and venous pressure of pipeline were observed before and after thrombolysis. Results After infusion pump of urokinase, the patency rate was 100%. Compared with pre-thrombolysis, the blood flow [ （271.25 ± 10. 25） ml/min vs （93. 13 ± 22. 72） ml/min], pipeline arterial pressure [ （ 11. 63 ± 2.91 ） nnn Hg vs （45.08 ± 11.27） mm Hg],and pipeline venous pressure [（13.01 ± 3.25） mm Hg vs （5.64 ± 1.41）ram Hg] significantly improved after infusion pump of urokinase （ all P 〈 0. 01 ） , which were in compliance with evaluation criteria of unobstructed catheter. There were no significant differences in prothrombin time, partial thromhoplastin time, levels of alanine aminotransferase and aspartate aminotransferase before and after thrombolysis （ all P 〉 0. 05 ）. Conclusion Infusion pump of urokinase is effective and safe in the treatment of catheter thrombosis with tunnel and polyester sleeve.