头孢唑啉-枸橼酸钠封管在维持性血液透析长期留置导管患者中的临床应用  

Application of the lock solution containing 1% cefazolin/30% sodium citrate for long-term indwelling catheters in maintenance hemodialysis patients

作　　者：胡兆雄[1] 肖厚勤[1] 费沛[1] 

机构地区：[1]湖北医药学院附属十堰市太和医院肾内科,十堰442000

出　　处：《中国血液净化》2013年第11期602-604,共3页Chinese Journal of Blood Purification

摘　　要：目的研究10mg/ml头孢唑啉-30%枸橼酸钠封管对维持性血液透析长期留置导管患者导管相关菌血症、导管功能不良发生率的影响。方法选择湖北医药学院附属十堰市太和医院肾内科使用长期留置导管的维持性血液透析患者25例,采取随机分组对照研究,试验组13例,采用10mg/ml头孢唑啉-30%枸橼酸钠封管,每周3次;对照组12例,全部使用肝素封管,每周3次,治疗6月,观察2组患者导管相关菌血症、导管功能不良的发生率及不良反应。结果试验组患者导管相关菌血症发生2例次,发生率0.85/1000导管日,导管功能不良发生11例次,发生率1.17%;对照组患者导管相关菌血症发生5例次,发生率2.29/1000导管日,导管功能不良发生25例次,发生2.87%;试验组导管相关菌血症发生率明显低于对照组(χ2=3.969,P=0.047),导管功能不良发生率显著低于对照组(χ2=6.739,P=0.009)。2组患者观察前及6个月后血清Ca2+、Mg2+、ALT、AST比较差异无统计学意义(P>0.05)。试验组不良反应发生率4.2‰,症状轻可自行缓解。结论与标准肝素封管相比较,10mg/ml头孢唑啉-30%枸橼酸钠封管能有效降低导管相关菌血症及导管功能不良的发生率,安全性良好。Objective To determine whether the lock solution of 1％ Cefazolin/30％ sodium citrate can prevent catheter-related bacteremia and reduce the incidence of catheter dysfunction.Methords This was a randomized,prospective and controlled study.A total of 25 hemodialysis patients were randomly assigned into the treatment group （n=l 3） in which 1％ cefazolin/30％ sodium citrate solution was applied into catheter lumen 3 times a week,or the control group （n=12） in which heparin was used as the lock solution 3 times a week for 6 months.The incidences of catheter-related bacteremia,catheter dysfunction,and other adverse reactions were recorded.Results Catheter-related bacteremia was 0.85/1,000 catheter days in the treatment group,and 2.29/1,000 catheter days in the control group （x2=3.969,P=0.047）; catheter dysfunction was 1.17％ in the treatment group,and 2.87％ in the control group （x2=6.739,P=0.009）.Serum Ca2＋,Mg2＋,ALT,AST were indifferent before and after the treatment and between the two groups （P＞0.05）.In the treatment group,side effect rate was 4.2‰,with spontaneous remission.Conclusion The lock solution containing 1％ Cefazolin/30％ sodium citrate can effectively reduce catheter-related bacteremia and catheter dysfunction with lower side effect rate,as compare with the heparin lock solution.

关 键 词：头孢唑啉 枸橼酸钠 血液透析 长期留置导管 

分 类 号：R318.16[医药卫生—生物医学工程]