尿激酶联合华法林治疗血液透析导管功能不良的效果观察

Effect observation of urokinase combined with warfarin in the treatment of hemodialysis catheter dysfunction

目的观察血液透析带涤纶套长期留置中心静脉导管并发功能不良使用尿激酶溶栓联合口服华法林钠抗凝治疗的疗效及安全性。方法选择医院血液透析中心2017年2月-2018年8月使用半永久(cuff)导管进行血液透析患者64例,随机分为治疗组和对照组各32例,在出现导管功能不良,并发导管血栓或纤维鞘相关血栓形成后,治疗组予以尿激酶联合华法林抗凝,对照组单纯予尿激酶溶栓治疗。比较2组透析过程中的血流量、静脉压、KT/V值及导管血栓复发率。结果2组患者均未出现因机体出血导致提前退出的情况。治疗组血流量、KT/V值均大于对照组,导管静脉压及导管血栓复发率均低于对照组,差异均有统计学意义(P<0.05)。结论尿激酶溶栓成功后联合华法林口服抗凝,在透析患者并发透析导管功能不良治疗中疗效较好,导管通畅度及血栓的再发生率明显低于单纯尿激酶溶栓治疗,值得临床推广使用。

Objective To investigate the clinical efficacy and security of urokinase thrombolysis combined with oral warfarin sodium anticoagulant therapy after hemodialysis belt polyester sleeve long-term indwelling tunneled central venous catheters concurrent dysfunction.Methods 64 patients with hemodialysis were selected from the hospital hemodialysis center from February 2017 to August 2018 using a semi-permanent(cuff)catheter.They were randomly divided into treatment group and control group,each of 32 cases.After catheter dysfunction,concurrent catheter thrombosis or fibronectin-related thrombosis,the treatment group was treated with urokinase combined with warfarin,and the control group was treated with urokinase thrombolysis.The blood flow,venous pressure,KT/V value,and catheter thrombus recurrence rate were compared between the two groups.Results There were no cases of early withdrawal due to body bleeding in both groups.The blood flow and KT/V values in the treatment group were higher than those in the control group,the catheter venous pressure and catheter thrombus recurrence rate were lower than the control group,and the difference was statistically significant(P<0.05).Conclusion After successful urokinase thrombolysis,combined with warfarin oral anticoagulation,it is effective in the treatment of dialysis patients with dialysis catheter dysfunction,the catheter patency and thrombosis recurrence rate is significantly lower than the simple urokinase thrombolytic therapy,which is worth clinicalpopularization and application.