70%乙醇封管在血液透析带隧道带涤纶套导管中的应用  

Application of 70% ethanol lock for tunnel cuffed catheter in maintenance hemodialysis patients

作　　者：刘宏[1] 孙晓萌[1] 张留平[1] 高民[1] 魏青[1] 刘必成[1] 

机构地区：[1]东南大学附属中大医院肾脏科,南京210009

出　　处：《第二军医大学学报》2017年第3期329-334,共6页Academic Journal of Second Military Medical University

基　　金：江苏省肾脏病临床医学研究中心项目(BL2014080)~~

摘　　要：目的探讨70%乙醇封管对预防维持性血液透析带隧道带涤纶套(Cuff)导管患者导管相关性血流感染(catheter related blood stream infection,CRBSI)的有效性和安全性。方法本试验采用随机自身交叉对照方法。选择东南大学附属中大医院肾脏科维持性血液透析患者32例,首先将患者随机分为乙醇封管组(每周采用3.3mL 70%乙醇封管1次,再采用3.3mL标准肝素封管2次)和肝素封管组(每周采用3.3mL标准肝素封管3次),每组16例,22周后进行交叉互换。比较两组患者CRBSI、导管功能障碍和其他不良反应的发生率。结果 2例患者退出试验,2例死亡,共28例患者完成试验,每组各14例。乙醇封管组患者CRBSI的发生率为0.45/1 000导管日,低于肝素封管组患者(0.92/1 000导管日),但差异无统计学意义(P>0.05)。乙醇封管组患者导管功能障碍的发生率为0.90/1 000导管日,低于肝素封管组(2.06/1 000导管日),但差异无统计学意义(P>0.05)。两组患者的血常规、肝功能、凝血功能差异无统计学意义。乙醇封管组患者均未发生恶心、呕吐、头晕等不良反应。结论乙醇封管组维持性血液透析带隧道带Cuff导管患者的CRBSI发生率呈下降趋势,但与肝素封管组相比差异无统计学意义。Objective To explore the efficacy and safety of 70% ethanol lock for the prevention of catheter related blood stream infection（CRBSI）in maintenance hemodialysis（HD）patients with a tunnel cuffed central venous catheter.Methods A randomized self-crossover controled method was used in this study.A total of 32 HD patients with tunnel cuffed catheters,from the Department of Nephrology of Zhongda Hospital of Southeast University,were randomly assigned to ethanol lock group（the patients received 3.3mL 70%ethanol lock once a week and 3.3mL standard heparin lock twice a week）and heparin lock group（the patients received 3.3mL standard heparin lock three times a week）,each group with 16 patients,and the lock methods of two groups were exchanged after locking for 22 weeks.We then analyzed and compared the incidences of CRBSI,catheter dysfunction and another adverse reactions of the patients in two groups.Results Two patients withdrew from the study,two died,and totally 28 patients fully participated in the study,with each group haviny 14 patients.The incidence of CRBSI was 0.45 per 1 000catheter-days in ethanol lock group and was 0.92 per 1 000catheter-days in heparin lock group,showing significant difference between the two groups（P〉0.05）.There was no significant difference in the incidence of catheter dysfunction between the ethanol lock group and the heparin lock group（0.90 per 1 000catheter-days vs 2.06 per 1 000catheter-days;P〉0.05）.There were no significant differences in routine blood test,liver function or coagulation function between the two groups.The patients in the ethanol lock group were not observed with adverse reactions,including nausea,vomiting or dizziness.Conclusion The incidence of CRBSI has been declining in the maintenance HD patients with a tunnel cuffed catheter in the ethanol lock group,although it is not significantly different from the heparin lock group.

关 键 词：导管相关性血流感染 带隧道带Cuff导管 乙醇封管 肝素封管 血液透析 

分 类 号：R459.52[医药卫生—治疗学]