早期尿激酶应用对慢性肾衰竭静脉置管长期血液透析患者导管纤维蛋白鞘形成防治效果研究

Early Application of Urokinase in the Prevention and Treatment of Catheter-related Fibrin Sheath Formation in Patients with Chronic Renal Failure Undergoing Long-term Intravenous Catheterization for Hemodialysis

目的探讨早期尿激酶应用对慢性肾衰竭静脉置管长期血液透析患者导管纤维蛋白鞘形成的防治作用。方法选取我院2017年3月-2018年10月收治的慢性肾衰竭静脉置管长期血液透析患者85例,根据防治导管纤维蛋白鞘形成方法的不同分为观察组44例和对照组41例。观察组置管首次透析后即开始采用尿激酶封管法和滴注法防治导管纤维蛋白鞘形成;对照组置管首次透析后先采用常规肝素封管,待出现导管功能不良时再开始采用尿激酶封管法和滴注法防治导管纤维蛋白鞘形成。观察比较两组透析6个月后导管功能不良发生次数和首次导管功能不良出现时间;两组透析1、3及6个月时的血流量及静脉压;两组透析前及透析6个月时凝血酶原时间(PT)、凝血酶时间、纤维蛋白原、部分凝血酶时间;两组治疗期间不良反应发生情况。结果观察组导管功能不良发生次数明显少于对照组,首次导管功能不良出现时间明显晚于对照组,差异均有统计学意义(P<0.05或P<0.01)。透析3、6个月时观察组血流量明显大于对照组,静脉压明显低于对照组,差异均有统计学意义(P<0.05)。透析6个月时两组组内治疗前后比较,仅对照组PT降低(P<0.05);观察组透析6个月时PT明显长于对照组(P<0.05)。两组治疗期间均无严重不良反应发生。结论早期应用尿激酶可有效防治慢性肾衰竭静脉置管长期血液透析患者导管纤维蛋白鞘形成,且安全性良好,是一种防治长期血液透析留置导管功能不良的有效手段。

Objective To investigate the preventive effect of early urokinase application on the formation of catheter fibrin sheath in patients with chronic renal failure(CRF)undergoing long-term intravenous catheterization for hemodialysis.Methods From March 2017 to October 2018,85 patients with CRF undergoing long-term intravenous catheterization for hemodialysis in our hospital were enrolled in this study.They were divided into observation group(n=44)and control group(n=41)according to different methods of prevention and treatment of catheter-related fibrin sheath formation.After the first dialysis,in the observation group,urokinase sealing method and urokinase infusion method were used to prevent the formation of catheter-related fibrin sheath.After the first dialysis,in the control group,conventional heparin sealing method was first used,followed by urokinase sealing method and urokinase infusion method to prevent the formation of catheter-related fibrin sheath when the catheter function was poor.The occurrence rate of catheter dysfunction and the time of first catheter dysfunction at 6 months after dialysis in two groups were observed and compared.The blood flow and venous pressure at 1,3 and 6 months after dialysis,as well as the prothrombin time(PT),thrombin time(TT),fibrinogen(FIB),and activated partial thromboplastin time(APTT)at 6 months after dialysis were compared in two groups.Complications during treatment in both groups were compared.Results The occurrence rate of catheter dysfunction in the observation group was significantly lower than that in the control group,and the first time of catheter dysfunction was significantly later than that in the control group(P<0.05 or P<0.01).At 3 and 6 months after dialysis,the blood flow of the observation group was significantly higher than that of the control group,and the venous pressure was significantly lower than that of the control group(P<0.05).At 6 months after dialysis,PT was decreased exclusively in the control group(P<0.05),and PT in the observation group was significantly longer than that in the control group(P<0.05).There were no serious adverse reactions in the two groups.Conclusion Early application of urokinase can effectively prevent and treat the formation of catheter-related fibrin sheath in patients with CRF undergoing long-term intravenous catheterization for hemodialysis,with good safety.Therefore,it is an effective method to prevent and treat catheter dysfunction due to long-term intravenous catheterization for hemodialysis.