血液透析患者留置深静脉临时导管对血管内皮损伤标志物的影响  

To Analyze the Effect of Vascular Endothelial Injury Markers after Indwelling Deep Venous Catheter in Hemodialysis Patients

作　　者：颜伟健[1] 胡杨青[1] 王兴健[1] 李君科[1] 钟春花[1] 罗丽叶 YAN Weijian HU Yangqing WANG Xingjian et al(Department of Kidney of Affiliated Hospital of Shaoyang Uni- versity, Shaoyang City, Hu＇ nan Province 42200)

机构地区：[1]邵阳学院附属医院肾内科,湖南省邵阳市422000

出　　处：《医学理论与实践》2017年第13期1891-1893,共3页The Journal of Medical Theory and Practice

基　　金：湖南省教育厅自然科学研究项目(NO.15C1263)

摘　　要：目的:通过检测血液透析患者留置右颈内静脉临时导管后血浆中血管性血友病因子(von Willebrand Factor,vWF)、血栓调节蛋白(Thrombomodlin,TM)及一氧化氮合成酶(Nitric Oxide Synthase,NOS)水平的变化,了解穿刺部位血管的损伤情况。方法:选取我院留置右颈内静脉临时导管血液透析患者47例,用酶联免疫吸附法(ELISA)检查置管前、后不同时间点的vWF、TM、NOS水平。结果:(1)47例患者留置右颈内静脉临时导管后血管继发改变42例,占89.36%;(2)置管后vWF、TM水平升高,置管后NOS水平下降,并随着留置导管时间延长改变更加明显;(3)血管继发改变组置管后3周组与4周组vWF、TM水平高于无血管继发改变组(P<0.05),血管继发改变组置管后4周组NOS水平低于无血管继发改变组(P<0.05)。结论:血液透析患者留置右颈内静脉临时导管后穿刺部位血管可出现内径狭窄、附壁血栓、内膜增厚继发改变;vWF、TM、NOS水平的变化与血管继发改变密切相关,留置临时导管后3~4周可能为穿刺部位血管损伤高峰期。Objective：To observe the changes of plasma von Willebrand Factor（vWF）,Thrombomodlin（TM）and Nitric Oxide Synthase（NOS）after indwelling right internal jugular vein catheter in hemodialysis patients,and to analyze the vascular injuries in puncture site.Methods：Among the 47 cases of hemodialysis patients with indwelling right internal jugular vein catheter in our hospital,the levels of NOS,TM and vWF at different time were examined by enzymelinked immunosorbent assay（ELISA）.Results：（1）Among the 47 patients with indwelling right internal jugular vein temporary catheter,secondary changes of the internal jugular veinoccurred in 42 patients（89.36%）.（2）The levels of vWF and TM were significantly increased,while the level of NOS decreased significantly after indwelling catheter,and the changes were more obvious as time passed.（3）Among vascular secondary changes group,the levels of vWF and TM in the 3-week group and the 4-week group were higher than no vascular secondary changes group.The level of NOS in the 4-week group was lower than no vascular secondary changes group（P〈0.05）.Conclusion：The puncture site vascular stenosis,mural thrombus and intimal thickening are the secondary changes of internal jugular vein after temporary catheter in hemodialysis patients.Changes of plasma vWF,TM and NOS levels were closely related to the secondary changes of the blood vessels.3~4 weeks after indwelling temporary catheter may be the peak of vascular injury in the puncture site.

关 键 词：临时导管 血管损伤 血管性血友病因子 血栓调节蛋白 一氧化氮合成酶 

分 类 号：R459.5[医药卫生—治疗学]