枸橼酸定期封管对血液透析患者长期留置导管通畅性和并发症的影响

Effect of periodic sealing with citric acid on the patency and complications of long-term indwelling catheters in hemodialysis patients

目的观察枸橼酸定期封管对血液透析患者长期留置导管通畅性和并发症的影响,旨在进一步明确枸橼酸定期封管方法在临床上的应用价值,提升血液透析长期留置导管的维护水平,积极预防导管相关并发症的发生。方法选取2021年1月至2022年12月九江市中医医院血透室收治的80例血液透析长期留置导管患者作为研究对象,按照随机数字表法将其分为研究组(40例)和对照组(40例),对照组采用常规肝素生理盐水(5000 U/ml)封管,研究组使用4%枸橼酸钠液定期封管,比较两组血管通路情况(导管血流量、导管通畅率)、并发症(出血、消化道反应、导管相关感染等)、负性情绪[Zung焦虑自评量表(SAS)与Zung抑郁自评量表(SDS)]及满意度情况。结果研究组患者血流量、透析期间导管通畅率高于对照组,差异有统计学意义(P<0.05);研究组出血、消化道反应及导管相关感染总发生率低于对照组,差异有统计学意义(P<0.05);干预后,两组SAS、SDS得分均低于本组干预前,且研究组SAS、SDS低于对照组,差异有统计学意义(P<0.05);研究组总满意度高于对照组,差异有统计学意义(P<0.05)。结论枸橼酸定期封管利于保障血液透析患者长期留置导管通畅性,提高导管血流量,同时能够降低导管相关感染、出血等不良并发症发生风险,且该封管方案对改善患者负性情绪、提高满意度也具有重要意义,故推荐在临床相关长期留置导管患者中开展。

Objective To observe the effect of periodic citrate sealing on the patency and complications of long-term indwelling catheters in hemodialysis patients,aiming to further clarify the clinical application value of periodic citrate sealing method,improve the maintenance level of long-term indwelling catheters in hemodialysis,and actively prevent the occurrence of catheter-related complications.Methods A total of 80 patients with long-term indwelling catheters in hemodialysis admitted to the hemodialysis room of Jiujiang Traditional Chinese Medicine Hospital from January 2021 to December 2022 were selected as the study objects.They were divided into study group(40 cases)and control group(40 cases)according to random number table method.The control group were sealed with conventional heparin physiological saline(5000 U/ml),while the study group were regularly sealed with 4%sodium citrate solution.The vascular access conditions(catheter blood flow,catheter patency rate),complications(bleeding,gastrointestinal reactions,catheter-related infections,etc.)and negative emotions(Zang anxiety self rating scale[SAS]and Zung depression self rating scale[SDS])and satisfaction situation were compared between the two groups.Results The blood flow and catheter patency rate of the study group during dialysis were higher than those of the control group,and the differences were statistically significant(P<0.05).The total incidence of bleeding,gastrointestinal reactions,and catheter-related infections in the study group was lower than that of the control group,and the difference was statistically significant(P<0.05).After intervention,the SAS and SDS scores of the two groups were lower than those of the same group before intervention;the SAS and SDS scores in the study group were lower than those in the control group,and the differences were statistically significant(P<0.05).The overall satisfaction of the study group was higher than that of the control group,and the difference was statistically significant(P<0.05).Conclusion Regular sealing with citric acid is beneficial for ensuring the patency of long-term indwelling catheters in hemodialysis patients,improving catheter blood flow,and reducing the risk of adverse complications such as catheter-related infections and bleeding.This sealing scheme is also of great significance in improving negative emotions and increasing satisfaction in patients.Therefore,it is recommended to carry out it in clinically relevant long-term indwelling catheter patients.