尿激酶用于血液透析患者长期留置导管预防血栓形成的疗效

The Effect of Urokinase in the Prevention of Thrombosis of Long-term Indwelling Catheter in Hemodialysis Patients

目的:探讨尿激酶应用在血液透析患者长期留置导管中预防血栓形成的作用与价值。方法:选择我院2015年10月—2017年10月期间收治的40例进行血液透析的患者,均为其提供长期留置导管,采用随机数字表法将其分为20例观察组和20例对照组,我院提供给对照组患者血液透析后常规封管液封管处理,提供给观察组患者每月一次血液透析前微量泵5万单位尿激酶与10mL 0.9%生理盐水进行治疗,长期留置导管动静脉,并控制两端5mL和10mL/h速度,确保半小时完成。比较两组患者透析血流量、留置导管阻塞率、留置导管感染率等导管情况,患者血小板计数、PT凝血酶原时间、TT凝血酶时间、FIB纤维蛋白原、NIR国际标准化比值等指标情况以及出现导管口出血、牙龈出血、皮肤黏膜出血等不良反应情况。结果:观察组患者透析血流量高于对照组,留置导管阻塞率及留置导管感染率明显比对照组患者低,P<0.05。在血液指标方面,观察组患者血小板计数为(176.4±37.7)10~9/L,高于对照组的(149.5±32.4)10~9/L,P<0.05,其他指标两组数据对比无差异,P>0.05。另外,观察组出现导管口出血、留置导管周围渗血的情况各1例,不良反应发生率为10%,对照组患者共出现9例,发生率为45%,高于观察组,P<0.05。结论:将尿激酶应用在血液透析患者长期留置导管中,有助于改善患者导管的通畅情况,降低发生堵塞、感染和血栓的几率,应用安全可靠,具有很高的价值。

Objective: To investigate the role and value of urokinase in preventing thrombosis in long-term indwelling catheter in hemodialysis patients. Methods: 40 patients with hemodialysis were selected from October 2015 to October 2017 in our hospital, all of whom were provided with long-term indwelling catheter. They were divided into 20 observation group and 20 control group by random digital table method. After routine hemodialysis, the patients in the observation group were treated with micropump 50 000 units of urokinase and 10 mL 0.9% normal saline before hemodialysis, and remained for a long time. Long-term indwelling catheter arteries and veins, and control the speed of 5 ml and 10 mL/h at both ends to ensure half an hour completion. The blood flow rate, catheterization rate, platelet count, PT prothrombin time and TT thrombin time were compared between the two groups. FIB fibrinogen and the international standard ratio of NIR and other adverse reactions such as catheter bleeding gingival bleeding and skin and mucosal bleeding were observed. Results: The hemodialysis blood flow in the observation group was higher than that in the control group, the obstruction rate of indwelling catheter and the infection rate of indwelling catheter were significantly lower than those in the control group (P<0.05). The platelet count in the observation group was (176.4±37.7) 109 / L, which was higher than that in the control group (149.5±32.4) 109 / L (P<0.05). There was no difference between the other two groups (P>0.05). In addition, there was bleeding at the catheter orifice in the observation group, and the incidence of adverse reactions was 10 in the observation group (1 case), and the incidence rate was 45%(9 cases) in the control group, which was higher than that in the observation group (P<0.05). Conclusion: The application of urokinase in long-term indwelling catheter in hemodialysis patients is helpful to improve the patency of catheter and reduce the incidence. It has a high value in the treatment of clogging, infection and thrombus risk, with high safety and reliability.