高剂量尿激酶封管联合泵入治疗尿毒症维持性血液透析带隧道带涤纶套导管功能不良的临床效果  

Clinical efficacy of tube sealing combined with pump infusion with high-dose urokinase for tunneled cuffed catheter-related dysfunction in uraemia patients with maintenance hemodialysis

作　　者：张玲[1] 李益明[1] 邢小珍 王志芳[1] 姜金孝 祝亮[1] 鲁庆红 

机构地区：[1]湖北省黄冈市中心医院肾脏病学科,黄冈市438000

出　　处：《广西医学》2016年第8期1101-1105,共5页Guangxi Medical Journal

摘　　要：目的 观察高剂量尿激酶导管内封管联合微泵泵入治疗尿毒症维持性血液透析患者带隧道带涤纶套导管（TCC）功能不良的临床效果。方法 将93例TCC功能不良的维持性血液透析患者分成A组30例、B组31例、C组32例。A组采用2万U尿激酶导管封管；B组20万单位尿激酶导管封管；C组先将20万U尿激酶导管封管，30 min后抽出，再将40万U尿激酶溶于40 ml生理盐水中，各取20 ml分别从导管动静脉端用微泵泵入维持治疗0.5 h。比较3种方法的溶栓效果、溶栓次数、血栓复发情况、连续使用留置导管时间及不良反应等。结果 C组患者溶栓成功率及一次性再通率最高（P＜0.05），2年内复发率最低（P＜0.05），连续使用留置导管时间最长（P＜0.05）。B组患者一次性再通率高于A组，而反复溶栓2～3次再通率低于A组（P＜0.05）。3组均未发生明显副作用及并发症。结论 高剂量尿激酶导管内封管联合微泵泵入治疗尿毒症维持性血液透析TCC功能不良高效、方便、一次性再通率高、溶栓治疗次数减少、复发时间及连续使用留置导管时间延长，相对安全，可用于血栓形成时间较长、反复局部封管溶栓效果差的患者。Objective To observe the clinical efficacy of tube sealing combined with miuipump infusion with high-dose urokinase for tunneled cuffed catheter（TCC）-related dysfunction in uraemia patients with maintenance hemodialysis. Methods Ninty-three patients with maintenance hemodialysis were diagnosed as TCC-related dysfunction, and were randomized into Group A （ n = 30） , Group B （ n = 31 ） and Group C（n = 32）. Group A was treated with tube sealing using 20 000 U urokinase. Group B was treated with tube sealing using 200 000 U urokinase. Group C was treated with tube sealing using 200 000 U urokinase, then the urokinase was extracted 30 minutes later. A total of 400 000 U urokinase were dissolved with 40 ml normal saline ,and 20 ml solution was infused into catheter through venous and arterial lines respectively using minipump for 30 minutes. The efficacy of thrombolysis, times of thrombolytie therapy, recurrent embolism, duration of indwelling catheter patency and complications were compared among three groups. Results Group C obtained the highest thrombolytic success rate and one-time recanalization rate（ P 〈 0.05 ）, the lowest recurrent rate within 2 years （P 〈 0.05 ） and the longest duration of indwelling catheter patency （P 〈 0.05 ）. Compared to Group A, the one-time recanalization rate was higher and the recanalization rate after thrombolysis for twice or three times was lower in Group B（P 〈0. 05）. No significant adverse events and complications were observed in the three groups. Conclusion Tube sealing combined with minipump infusion with high-dose urokinase for TCC-related dysfunction is effective and convenient. It can obtain higher one-time recanalization rate ,reduce the times of thrombolytic therapy ,and prolong the duration of recurrence and indwelling catheter patency. This approach is relatively safe,which can be applied to the patients with long formation time of embolism or poor efficacy after repeated local throbolysis with tube sealing.

关 键 词：血液透析 导管功能不良 带隧道带涤纶套导管 尿激酶 高剂量 泵入治疗 

分 类 号：R459.5[医药卫生—治疗学]