目的 血液透析长期导管是透析患者重要的血管通路之一,然而其功能障碍和感染仍然比较频繁.透析间期华法林抗凝对血液透析导管的通畅性的维持可能会有益.本研究前瞻性地比较了透析间期口服华法林抗凝和不服抗凝剂2种方法的长期结果.方法 从2006年1月至2011年1月,309例Permcath隧道导管植入慢性血液透析患者颈内静脉,144例使用华法林抗凝和165例不使用抗凝剂.前瞻性随访患者导管感染和通畅率.结果抗凝治疗组的平均导管存活(无功能障碍)时间比对照组明显延长(31.8±0.9 月比 22.0±1.2月,P＜0.01),3年通畅率也明显增高(82.6%比51.5%,P =0.003).2组导管感染率明显降低(5.6% 比14.5%,P＜0.05).结论透析间期口服适量的华法林能明显延长透析患者长期导管的使用寿命,并减少患者的导管血栓形成率和感染率.%Objective Long-term indwelling catheter is an alternative approach for vascular access in hemodialysis patients.However, complications such as thromboses and infections often lead to catheter dysfunction.To investigate the effect of anticoagulation on catheter patency, we used warfarin between dialysis sessions m hemodialysis patients with tunneled, cuffed and indwelling catheters in right internaljugular vein.Method In a cohort of 309 hemodialysis patients implanted with cuffed dual-lumen catheters in right jugular vein as vascular access, 144 patients took adjusted doses of warfarin between dialysis sessions, and the remaining 165 cases without anticoagulation medication were served as controls.Catheter patency and infection rate were monitored.The study end point arrived when their blood flow during a dialysis session became ＜200ml/min, they had refractory catheter infection, or their observation period reached to 36 months.Results The average survival period of catheter was significantly longer in anticoagulant group than in control group (3 1.8±0.9 months vs.22.0 + 1.2 months, P ＜0.0 1).Moreover, patients in anticoagulant group had a higher 3-year patency rate (82.6％ vs 5 1.5 ％, p = 0.00 3) and a lower catheter infection rate (5.6％vs 14.5％, P＜0.05).Conclusion Warfarin is effective in extending catheter patency period and lowering local infection rate.
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