Objective To investigate the efficacy and security of different concentrations of heparin applied in sealing temporary dialysis catheter. Methods Sealed temporary dialysis catheter when dislysis were completed using different concentrations of heparin of 1.5% ,2.5% , 5% , respectively. Observed adverse reactions including hemorrhage and catheter thrombosis after sealing the dialysis catheter, compared levels of clotting time and changes of platelet, analysed the incidence of catheter dysfunction and the situation of applications of thrombolytic drugs. Results ①17 patients of 1.5% sodium heparin group used 799 catheter - days, average 47 catheter - days, and 4 patients of them exited as a result of catheter infection occurred ; 31 patients of 2. 5% sodium heparin group used 1 829 catheter - days, average 59 catheter - days, and 4 patients exited as a result of catheter infection occurred; 25 patients of 5% sodium heparin group used 1 600 catheter - days, average 59 catheter - days, and one of them exited as a result of catheter infection occurred. ②The PT and APTT of 5% sodium heparin group prolonged after catheter sealed ( P <0. 05 ), while the other two groups had no significant effection on coagulation. ③The incidence of catheter thrombosis in 1. 5% sodium heparin group was higher than 5% sodium heparin group ( P < 0. 05 ). However, the incidence of catheter - aborted among three groups showed no statistical significances. ④There were no allergic reactions to heparin in all three groups. The platelet of one person in 2. 5% sodium heparin group showed slightly decrease at the 31st days after intubation,which was 6.7 × 1010/L, without thromboembolism. Conclusion The incidence of adverse reactions of 5% sodium heparin group is lower than the other two groups, but has adverse effect on the PT and APTT; The incidence of catheter thrombosis of 1. 5% sodium heparin group is higher than the other two groups and is infected more easily. While application of 2. 5% sodium heparin group to seal temporary central venous catheter is safe and effective, which has low incidence of catheter thrombosis and no significant effect on blood coagulation , so it can be used to seal temporary dialysis catheter instead of 5% sodium hep-arin group. Nevetheless, the platelet of one person in this study showed slightly decrease after heparin - applied, so it is necessary to pay attention to occurrence of thrombopenia induced by application of heparin even without thromboembo-lism.%目的 研究在临时性血液透析导管封管时使用不同浓度肝素的有效性及安全性.方法 在透析结束时使用1.5%、2.5%、5%肝素钠进行导管内封管,观察封管后不良反应,包括封管后出血、导管内血栓形成等;比较封管前后出凝血时间水平及血小板的变化;统计导管功能不良的发生率及溶栓药物使用情况等.结果 ①1.5%肝素钠组17例患者,累计使用799导管日,平均47导管日,有4例患者因导管感染退出;2.5%肝素钠组31例患者累计使用1 829导管日,平均59导管日,有4例患者因导管感染退出;5%肝素钠组25例患者累计使用1 600导管日,平均59导管日,有1例患者因导管感染退出.②5%肝素钠组凝血酶原时间(PT)、部分凝血活酶时间(APTT)在封管后延长(P<0.05),而其他组对凝血指标无明显影响.③1.5%肝素钠组血栓发生率高于5%肝素钠组(P<0.05),3组导管功能不良发生率之间无统计学差异.④3组患者均无肝素过敏等反应,2.5%肝素钠组有1例患者插管后第31天出现血小板轻度减少,为6.7×1010/L,但无血栓栓塞并发症.结论 5%肝素钠组导管不良反应发生率最低,但对出凝血时间有影响,1.5%肝素钠组导管内血栓发生率高于其他2组,且易感染.而2.5%肝素钠组用于临时性中心静脉导管封管相对安全有效,导管内血栓发生率低,且对出凝血指标无明显影响,可以替代5%肝素钠作一次性封管用.但本研究中有1例患者出现使用肝素后血小板减少,尽管无血栓发生,但须注意肝素诱发的血小板减少症的发生.
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