不同尿激酶溶栓方式在带涤纶套中心静脉导管功能不良中的疗效观察  

Efficacy of different urokinase thrombolytic methods in the treatment of dysfunction of central venous catheter with polyester sleeve

作　　者：于茜[1] 任琴琴[1] 赵晓晓 马志芳[1] 朱晗玉[1] Yu Qian;Ren Qinqin;Zhao Xiaoxiao;Ma Zhifang;Zhu Hanyu(Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases,Beijing Key Laboratory of Kidney Diseases, Beijing 100853, China)

机构地区：[1]解放军总医院第一医学中心肾脏病科、解放军肾脏病研究所、肾脏疾病国家重点实验室、国家慢性肾病临床医学研究中心、肾脏疾病研究北京市重点实验室,北京100853

出　　处：《中华肾病研究电子杂志》2020年第1期29-32,共4页Chinese Journal of Kidney Disease Investigation（Electronic Edition）

基　　金：国家自然科学基金(61971441、61671479)。

摘　　要：目的探讨不同的尿激酶溶栓方式治疗带涤纶套中心静脉导管功能不良的临床方案及安全性。方法选取2018年1月1日至2019年9月1日于我院使用带涤纶套中心静脉导管曾发生功能不良(≥1次/周,且2次以上)患者30例。所有患者均规律透析3次/周,按照随机数字表法随机分为A、B、C共三组,每组10例。另选取10例导管功能良好者,收集一般资料。A组采取尿激酶10万单位(wu)入生理盐水10 ml以1 ml/h分别用2个微量泵从导管的动脉和静脉端持续尿激酶泵入,余量2 ml静推入导管,每周1次,于透析前1日进行;B组尿激酶10 wu入生理盐水100 ml连接2个输液器,分别从导管的动脉和静脉端静滴,调整滴速以20 min输注完毕,每周1次,可于透析当日进行;C组尿激酶10 wu入生理盐水4 ml中分别连接导管动脉和静脉端封管式溶栓,20 min后抽吸,每周1次,可于透析当日进行。1个月后观察透析过程中各组血流量及压力值变化以及有无出血事件。结果经溶栓治疗后三组导管功能均有改善,A组较B组和C组血流量更高(P<0.01),且该组动静脉压力符合临床需求。结论微量尿激酶持续泵入治疗导管功能不良的效果较佳。Objective To explore the clinical strategies and safety of different urokinase thrombolytic methods in the treatment of dysfunction of central venous catheter with polyester sleeve.Methods 30 patients who had had dysfunction of central venous catheter with polyester sleeve(≥1 time/week,altogetrher more than 2 times)in our hospital from January 1,2018 to September 1,2019 were selected.All the patients were given regular dialysis 3 times/week,and randomly divided into three groups A,B,and C according to the random number method,with 10 patients each.Another 10 patients who had had a good function of the central venous catheter with polyester sleeve were also enrolled.Group A were given urokinase(100,000 units)in normal saline(10 ml)that was continuously pumped at a drip speed of 1 ml/h from the arteriovenous end of the catheter,and the last 2 ml was injected into the catheter on the day before dialysis once a week.Group B were given urokinase(100,000 units)in normal saline(100 ml)that was continuously pumped at a drip speed of 5 ml/min on the day of dialysis once a week;In group C,urokinase(100,000 units)in normal saline(4 ml)was given to the arteriovenous end of the catheter for thrombolysis in sealing the tube,and a suction was given after 20 minutes on the day of dialysis once a week.One month later,the changes of blood flow and pressure and the occurrence of bleeding events in each group were observed.Results After the thrombolytic therapies,the catheter function was improved in all the three groups.The blood flow volume of group A was greater than those of groups B and C(P<0.01),and the arteriovenous pressure of group A could meet the clinical needs.Conclusion The long-term effect of continuous pumping of small dose of urokinase was better in the treatment of catheter dysfunction.

关 键 词：尿激酶 溶栓治疗 带涤纶套中心静脉导管 血液透析 

分 类 号：R47[医药卫生—护理学]