不同浓度的肝素联合尿激酶封管对带cuff深静脉导管维持性血液透析患者的影响

Impact of heparin with different concentrations combined with urokinase sealing tube on maintenance hemodialysis patients with cuff deep venous catheter

目的探讨不同浓度的肝素以及尿激酶联合封管对带cuff深静脉导管维持性血液透析患者的影响。方法选取福州市第一医院血液透析中心2019年1月至2020年1月入组的终末期肾脏病采用带cuff长期透析导管维持性血液透析患者72例,随机分为A组24例予肝素3125 iu/ml联合尿激酶5000 iu/ml封管,B组24例予肝素3125 iu/ml联合尿激酶10000 iu/ml,C组24例予肝素6250 iu/ml联合尿激酶20000 iu/ml,观察时间1年,测定透析间期外周血白细胞、血红蛋白、血小板计数、白蛋白、肌酐、尿素氮、凝血时间(PT)、活化部分凝血酶时间(APTT)、D-D聚体,记录透析中血流量、静脉压波动值,观察血栓形成、导管相关性菌血症、出血风险事件的发生,并计算患者每周药物费用。结果三组观察对象的导管相关性菌血症发生率、出血发生率、外周血白细胞、血红蛋白、血小板计数、白蛋白、肌酐、尿素氮、PT、药物费用比较差异无统计学意义(P>0.05);血流量、静脉压波动值、血栓形成、APTT、D-D聚体比较差异有统计学意义(P<0.05)。结论较高浓度的肝素以及尿激酶联合封管未增加导管感染及患者出血风险,能够改善患者透析中血流量、静脉压波动值,减少导管功能不良的发生;虽然可能会导致透析患者凝血功能异常,但总体的出血发生率未增加,能够带来临床更好的获益。

Objective To investigate the impact of heparin with different concentrations combined with urokinase sealing tube on maintenance hemodialysis patients with cuff deep venous catheter.Methods A total of 72 patients with end-stage kidney disease with long-term dialysis catheter with cuff who were admitted to Hemodialysis Center of the First Hospital of Fuzhou from January 2019 to January 2020 were selected,and they were randomly divided into group A(n=24),where patients were sealed with heparin 3125 iu/ml combined with urokinase 5000 iu/ml,group B(n=24),where patients were sealed with heparin 3125 iu/ml combined with urokinase 10000 iu/ml,and group C(n=24),where patients were sealed with heparin 6250 iu/ml combined with urokinase 20000 iu/ml.The observation time was 1 year,and the peripheral blood leukocyte,hemoglobin,platelet count,albumin,creatinine,urea nitrogen,prothrombin time(PT),activated partial thrombin time(APTT),and D-D polymer were measured during dialysis interval.The fluctuation values of blood flow and venous pressure during dialysis were recorded,and the occurrence of thrombosis,catheterrelated bacteremia and hemorrhage risk events were observed.The weekly drug cost of patients was calculated.Results There were no statistically significant differences in the inci dence of catheter-related bacteremia,incidence of hemorrhage,peripheral blood leukocytes,hemoglobin,platelet count,albumin,creatinine,urea nitrogen,PT,and drug cost among the three groups of observation objects(P>0.05).There were statistically significant differences in blood flow,venous pressure fluctuation,thrombosis,APTT and D-D polymer(P<0.05).Conclusion The combined sealing tube of heparin with higher concentration and urokinase do not increase the risk of catheter infection and hemorrhage of patients.However,it can improve the fluctuation of blood flow and venous pressure during dialysis,and it can reduce the occurrence of catheter dysfunction.Although it may bring abnormal coagulation function to dialysis patients,the overall incidence of hemorrhage has not increased,which can br ing better clinical benefits.