华法林和拜阿司匹林在维持血液透析长期导管通畅中的作用比较  

作　　者：蔡晓青[1] 徐玉兰[2] 陈天新[2] 刘毅[2] 

机构地区：[1]温州医科大学附属乐清医院肾内科,325600 [2]温州医科大学附属第一医院肾内科,325015

出　　处：《浙江临床医学》2017年第2期210-212,共3页Zhejiang Clinical Medical Journal

摘　　要：目的比较华法林和拜阿司匹林在维持血液透析长期深静脉导管通畅中的作用及安全性。方法前瞻性观察2012年2月至4月温州市18家血液透析单位已服用拜阿司匹林抗凝的长期深静脉置管患者72例，在出现一次导管功能不良后随机分组为华法林组和拜阿司匹林组，并观察两组出现导管功能不良事件次数、年导管通畅率及出血情况等。结果华法林组和拜阿司匹林纽出现导管功能不良事件次数分别为0．63次／年和2．70次／年（P〈0．01）。两组年导管通畅率分别是50％和23．5％（P〈0．05）。华法林组出现3次大出血和7次小出血事件，而拜阿司匹林组有2例患者分别出现消化道出血和鼻衄（P〈0．01）。结论华法林（INR1．5-2．5）较拜阿司匹林（100mg／d）能更好地维持血液透析长期导管通畅，但出血风险明显增加。Objective To compare the effects of warfarin and bayaspirin to keep long-term catheter unblocked and security for hemodialysis. Methods Prospective observation were made on 72 cases of the patients with long-term catheter who were taking aspirin anticoagulation in 18 hemodialysis units in Wenzhou from February 2013 to April, they were randomly assigned to warfarin group and aspirin group after catheter dysfunction, then observe the conduit dysfunction and bleeding events between two groups. Results The conduit dysfunction events were 0.63 times / year and 2.70 times/year （ P〈0.01 ） in warfarin group and aspirin group. Malfunction-free catheter survival in a year was 50% and 23.5% in two groups. There are three major bleeding and seven minor bleeding events in warfarin group and 2 cases with gastrointestinal bleeding and epistaxis in the aspirin group （ P〈0.01 ） . Conclusions Warfarin （ INR1.5-2.5 ） is better to keep long-term hemodialysis catheter unblocked compared with aspirin （ 100mg/ day ） , but greatly increase bleeding risk.

关 键 词：华法林 阿司匹林 血液透析 长期导管 血栓形成 

分 类 号：R692.5[医药卫生—泌尿科学]