不同浓度尿激酶及停留时间对PICC堵管再通效果的体外模拟研究

In vitro simulation of different concentrations of urokinase and its residence time on the re-passage effect of PICC plugging

目的通过模拟体内环境制备经外周静脉置入中心静脉导管(PICC)血凝性堵管以获取研究样本,观察不同浓度尿激酶及其停留时间对PICC血凝性堵管再通效果的影响,以探讨临床处理PICC血凝性堵管的最佳尿激酶停留时间及高于常规浓度(5 000U/mL)的尿激酶溶液能否提高导管溶通率。方法采用在本院置管的30例患者提供的血液标本,每例患者的血液标本均在模拟体内环境下制备成血凝性堵塞的PICC导管样本各6例,总计180例,构成30行6列的样本矩阵,各列样本分别采用不同浓度尿激酶溶栓,浓度分别为5 000U/mL、10 000U/mL、20 000U/mL、30 000U/mL、40 000U/mL、50 000U/mL,同时,将样本矩阵第1~10行、11~20行、21~30行分别作为A组、B组、C组,3组样本尿激酶导管内停留时间分别为5min、15min、30min。统计全部样本溶通情况,包括是否溶通及再通时间,分别比较各列间及各组间样本平均溶通率及平均溶通时长,以得出尿激酶浓度和尿激酶停留时间对导管溶通率及溶通时长的影响程度;统计所有样本内气栓出现情况,包括气栓距导管头端距离,比较溶通样本和未溶通样本之间气栓距导管头端距离的差异。结果采用不同尿激酶浓度的各列样本之间溶通率及再通时间差异无统计学意义(P>0.05);采用不同尿激酶停留时间的各组样本溶通率差异无统计学意义(P>0.05),但各组平均溶通时长随尿激酶停留时间的递减而递减,差异有极显著意义(P<0.01);溶通样本内气栓距导管头端平均距离和未溶通样本内气栓距导管头端平均距离差异有极显著意义(P<0.01)。结论当尿激酶浓度高于5 000U/mL时,导管能否溶通,与导管内有无气栓或气栓与导管头端距离大小有关,距离越小越难溶通,而与尿激酶溶液浓度及溶液停留时间无关。当浓度高于"建议浓度"5 000U/mL时,导管溶通时长与尿激酶溶液浓度无关,但增加回抽次数,即缩短尿激酶停留时间,能显著缩短溶通时长。

Objective Preparation of PICC hemagglutination plugging by simulating in vivo environment to obtain research samples,to observe the effect of different concentrations of urokinase and its retention time on the re-opening,and to study the best time for clinical treatment of PICC hemagglutinating plugging,and whether or not the urokinase solution concentration higher than 5 000 U/mL can improve the catheterization rate.Method Voluntary blood samples from 30 patients in our hospital,each sample were prepared in a simulated in vivo environment into 6 clot-blocked PICC catheter samples.A total of 180 cases,forming 30 rows and 6 columns of the sample matrix.Each column samples were treated with different concentrations of urokinase,including 5 000 U/mL,10 000 U/mL,20 000 U/mL,30 000 U/mL,40 000 U/mL and 50 000 U/mL respectively.The 1 st to 10 th,11 th to 20 th,and 21 st to 30 th rows of the sample matrix were designated as group A,group B,and group C respectively.These three samples of urokinase catheter residence time were 5 minutes,15 minutes and 30 minutes.The average dissolution rate and average dissolution time between each column and each group,the degree of influence of urokinase concentration and residence time on the rate of tube dissolution and time was compared.The occurrence of air embolism in all samples,including distance from the air-plug to the tip of the catheter.The difference between the distance of the airbrush from the catheter tip and the pass-through and the non-pass-through samples was compared.Result There was no significant difference in the rates of dissolution and recanalization between the samples of different urokinase concentrations（P〉0.05）.There was no difference in the dissolution rate of each group with different urokinase residence time（P〉0.05）.The average dissolution time in each group decreased with decreasing residence time of urokinase.The difference is significant（P〈0.01）.The average distance between the air-cap plug and the catheter tip in the diffusible sample,the average distance between the air-cap plug and catheter tip in the unsollowed sample were significantly different（P〈0.01）.Conclusion When urokinase concentration is higher than 5 000 U/mL,whether the catheter dissolved or not is related not only to the presence or absence of air embolism in the catheter,but also to the distance between the air-plug and the catheter tip,the smaller the more difficult to dissolve the distance,Unrelated to the concentration of urokinase and the residence time of the solution.However,increasing the number of withdrawals,shortening the urokinase residence time,can significantly shorten the duration of lysis.