不同剂量低分子肝素对血液透析长期导管通畅性的影响  

Effects of different doses of low molecular weight heparin on the patency rate of cuffed central venous catheter of hemodialysis

作　　者：李昕怡 王晓静[2] 陈伟 黄楠 LI Xinyi;WANG Xiaojing;CHEN Wei;HUANG Nan(Department of Physical Examination,363 Hospital,Chengdu,Sichuan 610041,P.R.China;Department of Internal Medicine,Wangjiang Hospital of Sichuan University,Chengdu,Sichuan 610041,P.R.China)

机构地区：[1]三六三医院健康体检部,成都610041 [2]四川大学望江医院内科,成都610041

出　　处：《华西医学》2020年第7期809-812,共4页West China Medical Journal

摘　　要：目的探讨血液透析时用于体外循环抗凝的不同剂量低分子肝素对导管通畅性的影响。方法回顾性纳入2012年6月—2018年1月三六三医院血液净化室使用长期导管作为血液透析通路的患者。根据血液透析时低分子肝素的剂量,分为<60 U/kg组和≥60 U/kg组,记录并统计两组的一般参数、尿激酶封管溶栓次数、出血事件、透析管路重度凝血例次及导管功能障碍的发生率。结果共纳入病例48例,其中<60 U/kg组31例,≥60U/kg组17例,两组在年龄、性别占比、是否糖尿病,以及血红蛋白、血小板、白蛋白、低密度脂蛋白胆固醇、超敏C反应蛋白参数方面比较,差异无统计学意义(P>0.05);<60 U/kg组和≥60 U/kg组导管功能障碍发生率分别为16.1%和29.4%(χ^2=0.507,P=0.476),出血事件分别为1.77次/1000导管日和2.81次/1000导管日(χ^2=1.500,P=0.221),差异皆无统计学意义;尿激酶使用次数分别为27.89次/1000导管日和36.18次/1000导管日(χ^2=5.927,P=0.015),管路严重凝血次数分别为6.88次/1000导管日和2.30次/1000导管日(χ^2=5.140,P=0.023),差异皆有统计学意义。结论在血液透析中使用小于60 U/kg的低分子肝素进行体外抗凝时,与使用大于等于60 U/kg的剂量相比并不降低血液透析长期导管的通畅率。Objective To explore the effect of different doses of low molecular weight heparin(LMWH)on the patency rate of cuffed central venous catheter used by patients for hemodialysis therapy.Methods From June 2012 to January 2018,patients who received long-term hemodialysis in 363 Hospital with cuffed central venous catheter were enrolled in this retrospective study.According to the dose of LMWH used in hemodialysis,they were divided into below60 U/kg group and greater than or equal to 60 U/kg group.The general parameters,frequency of urokinase use,bleeding events,severe coagulation in dialysis line and occurrence of catheter dysfunction were collected and compared between two groups.Results A total of 48 cases were enrolled.Of these,the doses of LMWH of 31 cases were below 60 U/kg and17 cases were greater than or equal to 60 U/kg.There was no significant difference between the two groups in terms of age,sex,diabetes,hemoglobin,platelets,albumin,low-density lipoprotein cholesterol,or hypersensitive C-reactive protein parameters(P>0.05).Between the below 60 U/kg group and the greater than or equal to 60 U/kg group,there was no statistically significant difference in the incidence of catheter dysfunction(16.1%vs.29.4%;χ^2=0.507,P=0.476)or the incidence of bleeding events(1.77 vs.2.81 times per 1000 catheter-days;χ^2=1.500,P=0.221).The frequency of urokinase used in the two group were 27.89 and 36.18 times per 1000 catheter-days,respectively(χ^2=5.927,P=0.015)and the frequency of severe coagulation were 6.88 and 2.30 times per 1000 catheter-days,respectively(χ^2=5.140,P=0.023).The differences were statistically significant.Conclusion The lower dose of LMWH used in hemodialysis for preventing extra-corporeal circuit thrombosis does not result in the decrease of the patency rate of cuffed central venous catheter.

关 键 词：低分子肝素 血液透析 导管通畅性 

分 类 号：R459.5[医药卫生—治疗学]