改良封管法对血透患者带隧道涤纶套导管的影响

Effect of modified sealing method on tunnelled-cuffed indwelling catheters in hemodialysis patients

目的探讨改良封管法对血液透析(血透)患者带隧道涤纶套导管的影响。方法 48例使用带隧道涤纶套导管进行血透患者,随机分为对照组和实验组,各24例。对照组采用常规封管治疗,实验组采用改良封管法(肝素和尿激酶交替封管)治疗。观察比较两组患者的导管血栓形成及导管堵塞情况;透析血流量;尿素清除指数(Kt/V)、导管留置时间。结果对照组及实验组的导管血栓形成率分别为25.10%和9.52%,导管堵塞率分别为23.70%和11.06%,实验组导管血栓形成率及导管堵塞率低于对照组,差异具有统计学意义(P<0.05)。对照组和实验组Kt/V分别为(1.266±0.273)和(1.318±0.205),透析血流量分别为(187.291±17.640)和(197.083±9.546)ml/min,导管留置时间分别为(13.208±6.107)和(17.000±2.719)个月。实验组的透析血流量及导管留置时间优于对照组,差异有统计学意义(P<0.05);两组Kt/V比较差异无统计学意义(P>0.05)。结论采用肝素与尿激酶交替封管可降低带隧道涤纶套导管的堵塞,延长导管的使用寿命。

Objective To discuss the effect of modified sealing method on tunnelled-cuffed indwelling catheters in hemodialysis patients.Methods A total of 48 hemodialysis patients with tunnelled-cuffed indwelling catheters were randomly divided into control group and experimental group,with 24 cases in each group.The control group was treated with conventional sealing,and the experimental group was treated with modified sealing method.Observation and comparison were made on catheter thrombosis,catheter blockage,dialysis blood flow,urea clearance index(Kt/V),catheter retention time in two groups.Results The control group and experimental group had catheter thrombosis rate respectively as 25.10%and 9.52%,catheter blockage rate respectively as 23.70%and 11.06%.The experimental group had lower catheter thrombosis rate and catheter blockage rate than the control group,and the difference was statistically significant(P<0.05).The control group and experimental group had Kt/V respectively as(1.266±0.273)and(1.318±0.205),dialysis blood flow respectively as(187.291±17.640)and(197.083±9.546)ml/min,and catheter retention time respectively as(13.208±6.107)and(17.000±2.719)months.The experimental group had better dialysis blood flow and catheter retention time than the control group,and the difference was statistically significant.Their difference was statistically significant(P<0.05).Both groups had no statistically significant difference in Kt/V value(P>0.05).Conclusion Heparin and urokinase alternately sealing can reduce the blockage of tunnelled-cuffed indwelling catheters and prolong the service life of the catheter.