华法林和拜阿司匹林预防血液透析长期深静脉导管血栓形成的作用  

Effect of warfarin and Bayeraspirin in the prevention of long-term catheter thrombosis in hemodialysis

作　　者：蔡晓青[1] 周莹[1] 黄丽丹 张明慧[1] 刘毅[1] 

机构地区：[1]温州医科大学附属第一医院肾内科,浙江温州325000 [2]永嘉县人民医院血透室,浙江温州325100

出　　处：《温州医学院学报》2013年第12期823-825,共3页Journal of Wenzhou Medical College

基　　金：温州市科技局经费自筹项目(20110129)

摘　　要：目的：比较华法林和拜阿司匹林在预防血液透析长期深静脉导管血栓形成中的不同作用。方法：观察温州医科大学附属第一医院2009年12月至2012年7月长期深静脉置管后服用拜阿司匹林（每日100mg）抗凝的患者18例，在出现2～3次导管功能不良事件后改为口服华法林，目标国际标准化比值（INR）为1．5～2．5进行抗凝治疗。通过前后自身对照比较华法林组和拜阿司匹林组平均每1000个导管日出现导管功能不良事件的次数、尿激酶的平均用量及出血情况。结果：拜阿司匹林组和华法林组出现导管功能不良事件次数分别为6．9次／1000个导管日和4．1次／1000个导管日（P〈0．05），尿激酶平均用量分别为262万U／1000个导管日和88万U／1000个导管日（P〈0．05）。18例患者在服用拜阿司匹林期间无明显出血倾向，而在服用华法林期间出现7次小出血和1次大出血事件（P〈0．05）。结论：华法林（INR为1．5—2．5）较拜阿司匹林（每日100mg）能更好地预防血液透析长期深静脉导管血栓形成，维持管路通畅，但出血风险相对较大。Objective： To compare the difference of warfarin and Bayeraspirin to prevent long-term centralvenous catheters thrombosis in hemodialysis. Methods： Between December 2009 and July 2012, 18 patients with long-term central-venous catheters after taking B ayeraspirin （100 mg/d） for anticoagulant were identified, in case of two or three episodes of catheter disfunction ecurred and changed to take orally dose-adjusted warfarin, target International Normalized Ratio（INR） was 1.5-2.5, and compared the catheter disfunction episodes between the two groups during every 1 000 catheter days, the average amount of urokinase units and bleeding events. Results： The group of Bayeraspirin and warfarin appeared catheter disfunction events were 6.9 episodes/1 000 catheter days and 4.1 episodes/1 000 catheter days （P〈0.05）, the average amount of urokinase was 2.62 million units/1 000 catheter days and 0.88 million units/1 000 catheter days respectively （P〈0.05）. There was no bleed when taking Bayeraspirin, but 7 minor bleeds, and one major bleed when taking warfarin （P〈0.05）. Conclusion： Warfarin （target INR1.5-2.5） can better prevent long-term central-venous catheter thrombosis in hemodialysis than Bayeraspirin, maintain catheter unobstructed, but has a greater bleeding risk relatively.

关 键 词：华法林 阿司匹林 血液透析 中心静脉导管 血栓形成 

分 类 号：R459[医药卫生—治疗学]