不同浓度和容量的封管液对中心静脉导管渗漏的影响  

Effect of different concentration and volume of locking fluid on central venous catheter leakage

作　　者：曾艳[1] 洪富源[2] 林苗[2] ZENG Yan;HONG Fuyuan;LIN Miao(Provincial Clinical Medical College of Fujian Medical University,Fujian Province,Fuzhou350001,China;Department of Nephrology,Fujian Provincial Hospital,Fujian Province,Fuzhou350001,China)

机构地区：[1]福建医科大学省立临床医学院,福建福州350001 [2]福建省立医院肾内科,福建福州350001

出　　处：《中国当代医药》2023年第23期54-58,共5页China Modern Medicine

基　　金：福建省自然科学基金面上项目(2019J01185)。

摘　　要：目的通过体外实验,观察不同容量、不同浓度封管液对中心静脉导管渗漏情况的影响,以探索安全、有效的封管策略。方法根据葡萄糖浓度及封管液体积分为4个实验组:10%葡萄糖标定容量封管组(LV组)、25%葡萄糖标定容量封管组(HV组)、10%葡萄糖4/5标定容量封管组(LLV组)、25%葡萄糖4/5标定容量封管组(HLV组)。通过建立恒温体外循环装置模拟人体环境,各组按要求封管,观察封管后30 s,10、30 min,1、4、12、24、48 h导管渗漏率及导管动静脉尖端封管液浓度变化,并比较各组间随时间发生的浓度变化,依此选择相对理想的封管方案。结果48 h总体渗漏率:HV组>LV组>HLV组>LLV组。LV组、HV组封管后30 s导管动脉侧(A端)、静脉侧(V端)浓度即开始下降,LLV组与HLV组在封管后前10 min各端浓度无变化。最终LV组A端浓度(303.22±0.97)mmol/L,V端浓度(307.67±1.09)mmol/L;HV组A端浓度(607.50±0.66)mmol/L,V端浓度(612.78±0.70)mmol/L;LLV组A端浓度(452.78±0.41)mmol/L,V端浓度(455.09±1.35)mmol/L;HLV组A端浓度(921.63±1.41)mmol/L,V端浓度(925.49±0.85)mmol/L。各组全时段A端浓度均低于V端,差异有统计学意义(P<0.05)。结论四组封管方案均有不同程度渗漏,综合考虑安全性及有效性,4/5标定容量的高浓度封管方案更为理想。另外,封管液侧孔渗漏率大于尖端,可以考虑两端不同浓度的封管策略以防范血栓风险。Objective To observe the effect of different volume and concentration of sealing solution on the leakage of central venous catheter in vitro,and to explore the safe and effective sealing strategy.Methods According to the concentration of glucose and the sealing fluid score,four experimental groups were divided:10%glucose calibration volume sealing group(LV group),25%glucose calibration volume sealing group(HV group),10%glucose 4/5 calibration volume sealing group(LLV group),25%glucose 4/5 calibration volume sealing group(HLV group).By establishing a constant temperature extracorporeal circulation device to simulate the human environment,the tube was sealed according to the requirements of each group.The leakage rate of catheter and the concentration of sealing fluid at the arterial and venous tips of catheter were observed at 30 s,10 min,30 min,1 h,4 h,12 h,24 h,48 h after sealing,and the concentration changes over time were compared among the groups.Results The overall leakage rate at 48 hours was HV group>LV group>HLV group>LLV group.In LV group and HV group,the concentration of arterial side(A end)and venous side(V end)began to decrease 30 s after sealing the catheter,while in LLV group and HLV group,the concentration of each end did not change during the first 10 min after sealing the catheter.In LV group,the A-end concentration was(303.22±0.97)mmol/L,and the V-end concentration was(307.67±1.09)mmol/L.HV group A end concentration was(607.50±0.66)mmol/L,V end concentration was(612.78±0.70)mmol/L.In LLV group,the A-end concentration was(452.78±0.41)mmol/L,and the V-end concentration was(455.09±1.35)mmol/L.The A-terminus concentration of HLV group was(921.63±1.41)mmol/L,and the V-terminus concentration was(925.49±0.85)mmol/L.The concentrations of the A-terminus were lower than those of the V-terminus in each group at all time points,and the differences were statistically significant(P<0.05).Conclusion All the four sealing schemes have different degrees of leakage.Considering the safety and effectiveness,

关 键 词：血液透析 中心静脉导管 肝素 个体化封管 

分 类 号：R459.5[医药卫生—治疗学]