慢性肾功能衰竭长期血液透析导管纤维蛋白鞘形成的防治方案研究

摘要

目的：探讨慢性肾功能衰竭长期血液透析患者导管内纤维蛋白鞘形成的防治方案。方法收集2010年1月至2014年6月来石家庄市第一医院救治的慢性肾功能衰竭长期血液透析的患者80例为研究对象，按患者就诊的顺序随机将患者分为试验组与对照组。试验组患者在留置导管时就应用尿激酶进行封管及滴注；对照组患者在出现导管的不良反应后再使用尿激酶进行封管及滴注。6个月后观察与比较两组患者的导管功能、静脉压、平均血流量、凝血的功能及并发症等。结果试验组患者动脉端与静脉端导管功能不良反应发生率均低于对照组，试验组首次发生导管功能不良反应的时间明显短于对照组。置管1个月时两组患者的平均血流量及静脉压差别不大；置管3个月时试验组患者的平均血流量明显大于对照组，而平均静脉压两组差别不大；置管6个月时试验组患者的平均血流量明显大于对照组，平均静脉压明显低于对照组。结论对慢性肾功能衰竭长期血液透析患者早期进行尿激酶的封管及滴注能有效防治导管纤维蛋白鞘的形成。%Objective To probe the prevention and treatment program of catheter fibrin sheath formation in the patients with chronic renal failure long term hemodialysis .Methods 80 patients with chronic renal failure long term hemodialysis in the Shijiazhuang Municipal First Hospital from January 2010 to June 2014 were collected as the study subjects and divided into the experimental group and the control group according to the visiting sequence .The experimental group was given urokinase for tube sealing and instilling in indwelling catheter ,while the control group was given urokinase for tube sealing and instilling in the occurrence of adverse reactions .The catheter function ,ve‐nous pressure ,mean blood flow volume ,blood clotting function and complications after six months were observed and compared between the two groups .Results The occurrence rate of catheter function adverse reactions in the arterial and venous ends in the experimental group was lower than that in the control group and the time of catheter function adverse reactions in the experimental group was significantly shorter than that in the control group .The average blood flow volume and venous pressure at 1‐month indwelling catheter had little difference between the two groups;the mean blood flow volume at 3‐month indwelling catheter in the experimental group was significantly greater than that in the control group ,while the average venous pressure had little difference between the two groups;the average blood flow volume at 6‐month indwelling catheter in the experimental group was significantly greater than that in the control group and the venous pressure was significantly lower than that in the control group .Conclusion Early con‐ducting tube sealing and instilling of urokinase can effectively prevent the formation of catheter fibrin sheath forma‐tion in the patients with chronic renal failure long term hemodialysis .