枸橼酸封管液在维持性血透患者带Cuff中心静脉导管中的应用  

Application of Citrate Sealing Solution in Maintenance Hemodialysis Patients with Cuff Central Venous Catheter

作　　者：陈今[1] 孙淑清[1] 薛艳[1] CHEN Jin;SUN Shu-qing;XUE Yan(Department of Blood Purification,Fuzhou General Hospital of Nanjing Military Command,Fuzhou,Fujian Province,350025 China)

机构地区：[1]南京军区福州总医院血液净化科,福建福州350025

出　　处：《中外医疗》2018年第29期13-15,共3页China & Foreign Medical Treatment

摘　　要：目的探讨枸橼酸封管液在维持性血透患者带Cuff中心静脉导管中的应用效果。方法回顾性分析2014年9月—2016年8月该院收治的66例长期带Cuff中心静脉导管的维持性血液透析患者的临床资料,根据患者封管液的差异分为两组,将32采用肝素钠作为导管封管液的患者纳为对照组,将34例以枸橼酸钠作为导管封管液的患者纳为观察组。比较两组患者2年内导管相关性血流感染发生率、尿激酶封管次数、封管后24 h凝血指标[凝血酶原时间(PT)、活化部分凝血酶时间(APTT)、血小板计数(PLT)]以及其他并发症发生情况。结果随访2年,观察组导管相关性血流感染发生次数明显低于对照组(3次vs 13次),尿激酶封管次数明显低于对照组(308次vs 776次),出血事件发生率明显低于对照组(0.00%VS 18.75%),差异有统计学意义(χ~2=6.28、214.76、7.01,P<0.05);封管后24 h,对照组患者PT、APTT均较封管前显著延长,PLT明显降低,其延长或降低幅度均明显大于观察组[(17.9±3.8)s vs (13.8±3.4)s;(61.4±8.6)s vs (36.3±5.2)s;(100.0±32.7)×109/L vs (147.9±35.6)×109/L],差异有统计学意义(P<0.05)。结论枸橼酸钠封管液应用于维持性血液透析患者带Cuff中心静脉导管封管时,可有效减少患者导管相关性血流感染的发生,减少导管功能不良,并且能降低患者出血风险,安全性高,临床应用价值高。Objective To investigate the effect of citrate sealing solution in patients with maintenance hemodialysis with Cuff central venous catheter.Methods The clinical data of 66 patients with maintenance hemodialysis with long-term Cuff central venous catheter in the hospital from September 2014 to August 2016 were retrospectively analyzed.According to the difference of patients'sealing fluid,they were divided into two groups.The patients who used the catheter sealing solution were included in the control group,and 34 patients with sodium citrate as the catheter sealing solution were included in the observation group.The incidence of catheter-related bloodstream infection,the number of urokinase seals,and the 24 h coagulation index after prothrombotic[prothrombin time(PT),activated partial thrombin time(APTT),platelet count(PLT)]and other complications were compared between the two groups.Results After 2 years of follow-up,the number of catheter-related bloodstream infections in the observation group was significantly lower than that in the control group(3 times vs 13 times),and the number of urokinase sealing tubes was significantly lower than that in the control group(308 times vs 776 times).The incidence was significantly lower than that of the control group(0.00%vs.18.75%),and the difference was statistically significant(χ2=6.28,214.76,7.01,P<0.05);24 hours after sealing,the PT and APTT of the control group were significantly longer than that before sealing,and the PLT was significantly decreased.The prolongation or decrease was significantly greater than that of the observation group[(17.9±3.8)s vs(13.8±3.4)s;(61.4±8.6)s vs(36.3±5.2)s;(100.0±32.7)×109/L vs(147.9±35.6)×109/L],the difference was statistically significant(P<0.05).Conclusion Sodium citrate sealing solution can effectively reduce the incidence of catheter-related bloodstream infection,reduce catheter dysfunction,and reduce the risk of bleeding in patients with maintenance hemodialysis with Cuff central venous catheter sealing,with high sexuali

关 键 词：枸橼酸钠 维持性血液透析 CUFF导管 并发症 

分 类 号：R459.5[医药卫生—治疗学] R543.6[医药卫生—临床医学]