规律性尿激酶联合肝素封管预防血液透析患者长期留置导管功能不良的疗效观察

摘要

目的：探讨规律性尿激酶联合肝素封管对血液透析患者长期留置导管功能的改善作用。方法选取2013年2月至2015年2月在医院血液净化中心使用静脉留置导管进行血液透析患者46例，随机分为观察组和对照组，每组23例。对照组采用肝素封管，观察组采用规律性尿激酶联合肝素封管，两组均给予优质护理。观察6个月后导管功能情况及透析相关指标，并记录药品不良事件发生情况。结果长期留置导管后，观察组导管堵塞、溶栓后未通、导管感染及拔管发生率分别为4.35%，0，4.35%，0，显著低于对照组的21.70%，13.04%，17.39%，8.70%，差异具有统计学意义( P＜0.05)；观察组透析血流量水平及尿素清除指数( Kt/V )均高于对照组，差异具有统计学意义( P＜0.05)；观察组患者不良反应发生率与对照组相当，差异无统计学意义（ P＞0.05）。结论采用规律性尿激酶联合肝素封管能改善血液透析患者长期留置导管的功能，提高透析的有效性，安全性好，配合适当的护理操作，有利于延长导管的使用寿命并减少感染，值得临床推广。%Objective To explore the efficacy of regular urokinase combined with heparin tube sealing on the catheter function of pa-tients with hemodialysis. Methods 46 cases of hemodialysis patients underwent USES long-term central venous indwelling catheter from February 2013 to February 2015 in the blood purification center were randomly divided into the observation group and the control group, 23 cases in each group. The control group used heparin sealing tube, and the observation group used heparin + urokinase sealing tube. Both groups received excellent nursing. The related indicators of dialysis and catheter function after 6 months of treatment were observed, and the occurrences of adverse drug events were recorded. Results After long-term indwelling catheter, the incidence rates of catheter obstruction, thrombolysis, catheter infections and decannulation in the observation group were 4. 35%, 0, 4. 35%, 0, which were significantly lower than 21. 70%, 13. 04%, 17. 39% and 8. 70% in the control group ( P < 0. 05 );the levels of dialysis blood flow and the Kt/V index in the observation group were higher than the control group, the differences were statistically significant ( P < 0. 05 );the incidence rate of adverse reactions in the observation group had no statistically significant difference with the control group ( P > 0. 05 ) . Conclusion The application of long-term deep vein indwelling catheter using urokinase combined heparin sealing tube can reduce the problems such as catheter obstruction, improve the effectiveness of dialysis, guarantee the safety of patients, which is worthy of clinical promotion.