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中华肾病研究电子杂志

中华肾病研究电子杂志 ›› 2020, Vol. 09 ›› Issue (01) : 29 -32. doi: 10.3877/cma.j.issn.2095-3216.2020.01.006

所属专题： 文献；

论著

不同尿激酶溶栓方式在带涤纶套中心静脉导管功能不良中的疗效观察
于茜1, 任琴琴1, 赵晓晓1, 马志芳1, 朱晗玉1,†()   
  1. 1. 100853　北京，解放军总医院第一医学中心肾脏病科、解放军肾脏病研究所、肾脏疾病国家重点实验室、国家慢性肾病临床医学研究中心、肾脏疾病研究北京市重点实验室
  • 收稿日期:2019-11-18 出版日期:2020-02-28
  • 通信作者: 朱晗玉
  • 基金资助:
    国家自然科学基金(61971441、61671479)

Efficacy of different urokinase thrombolytic methods in the treatment of dysfunction of central venous catheter with polyester sleeve

Qian Yu1, Qinqin Ren1, Xiaoxiao Zhao1, Zhifang Ma1, Hanyu Zhu1,†()   

  1. 1. Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Diseases, Beijing 100853, China
  • Received:2019-11-18 Published:2020-02-28
  • Corresponding author: Hanyu Zhu
  • About author:
    Corresponding author: Zhu Hanyu, Email:
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引用本文：

于茜, 任琴琴, 赵晓晓, 马志芳, 朱晗玉. 不同尿激酶溶栓方式在带涤纶套中心静脉导管功能不良中的疗效观察[J/OL]. 中华肾病研究电子杂志, 2020, 09(01): 29-32.

Qian Yu, Qinqin Ren, Xiaoxiao Zhao, Zhifang Ma, Hanyu Zhu. Efficacy of different urokinase thrombolytic methods in the treatment of dysfunction of central venous catheter with polyester sleeve[J/OL]. Chinese Journal of Kidney Disease Investigation(Electronic Edition), 2020, 09(01): 29-32.

目的

探讨不同的尿激酶溶栓方式治疗带涤纶套中心静脉导管功能不良的临床方案及安全性。

方法

选取2018年1月1日至2019年9月1日于我院使用带涤纶套中心静脉导管曾发生功能不良(≥1次/周，且2次以上)患者30例。所有患者均规律透析3次/周，按照随机数字表法随机分为A、B、C共三组，每组10例。另选取10例导管功能良好者，收集一般资料。A组采取尿激酶10万单位(wu)入生理盐水10 ml以1 ml/h分别用2个微量泵从导管的动脉和静脉端持续尿激酶泵入，余量2 ml静推入导管，每周1次，于透析前1日进行；B组尿激酶10 wu入生理盐水100 ml连接2个输液器，分别从导管的动脉和静脉端静滴，调整滴速以20 min输注完毕，每周1次，可于透析当日进行；C组尿激酶10 wu入生理盐水4 ml中分别连接导管动脉和静脉端封管式溶栓，20 min后抽吸，每周1次，可于透析当日进行。1个月后观察透析过程中各组血流量及压力值变化以及有无出血事件。

结果

经溶栓治疗后三组导管功能均有改善，A组较B组和C组血流量更高(P<0.01)，且该组动静脉压力符合临床需求。

结论

微量尿激酶持续泵入治疗导管功能不良的效果较佳。

关键词: 尿激酶, 溶栓治疗, 带涤纶套中心静脉导管, 血液透析
Objective

To explore the clinical strategies and safety of different urokinase thrombolytic methods in the treatment of dysfunction of central venous catheter with polyester sleeve.

Methods

30 patients who had had dysfunction of central venous catheter with polyester sleeve (≥1 time/week, altogetrher more than 2 times) in our hospital from January 1, 2018 to September 1, 2019 were selected. All the patients were given regular dialysis 3 times/week, and randomly divided into three groups A, B, and C according to the random number method, with 10 patients each. Another 10 patients who had had a good function of the central venous catheter with polyester sleeve were also enrolled. Group A were given urokinase (100, 000 units) in normal saline (10 ml) that was continuously pumped at a drip speed of 1 ml/h from the arteriovenous end of the catheter, and the last 2 ml was injected into the catheter on the day before dialysis once a week. Group B were given urokinase (100, 000 units) in normal saline (100 ml) that was continuously pumped at a drip speed of 5 ml/min on the day of dialysis once a week; In group C, urokinase (100, 000 units) in normal saline (4 ml) was given to the arteriovenous end of the catheter for thrombolysis in sealing the tube, and a suction was given after 20 minutes on the day of dialysis once a week. One month later, the changes of blood flow and pressure and the occurrence of bleeding events in each group were observed.

Results

After the thrombolytic therapies, the catheter function was improved in all the three groups. The blood flow volume of group A was greater than those of groups B and C (P<0.01), and the arteriovenous pressure of group A could meet the clinical needs.

Conclusion

The long-term effect of continuous pumping of small dose of urokinase was better in the treatment of catheter dysfunction.

Key words: Urokinase, Thrombolysis therapy, Central venous catheter with polyester sleeve, Hemodialysis
表1 四组一般临床资料情况
指标 A组 B组 C组 功能良好组 χ2/F值 P值
年龄 58.4±12.7 57.8±16.3 55.7±11.0 53.1±11.9 0.335 0.8
透析龄 29.0±11.6 27.0±27.0 28.8±9.3 24.0±12.5 0.46 0.712
性别 ? ? ? ? 1.191 0.898
? 男 5 6 4 6 ? ?
? 女 5 4 6 4 ? ?
原发病 ? ? ? ? 11.986 0.746
? 糖尿病肾病 4 5 3 2 ? ?
? 慢性肾小球肾炎 3 2 4 3 ? ?
? 高血压肾病 2 1 1 3 ? ?
? 药物性肾损害 1 0 2 1 ? ?
? 狼疮性肾炎 0 2 0 0 ? ?
? 梗阻性肾病 0 0 0 1 ? ?
表2 四组临床检验资料情况
指标 A组 B组 C组 功能良好组 χ2/F值 P值
Hb(g/L) 122.8±10.1 115.7±11.5 107.0±12.8 112.5±11.6 1.517 0.246
Plt(109/L) 202.0±83.4 174.3±54.5 159.0±46.6 197.7±53.8 0.516 0.677
Alb(g/L) 44.2±3.5 42.0±2.1 44.2±2.6 42.3±1.67 1.206 0.338
TC(mmol/L) 4.0±0.6 3.5±0.9 3.9±1.2 3.7±0.8 0.332 0.802
TG(mmol/L) 1.7(1.6，3.1) 1.9±0.8 1.8±0.8 1.5±0.6 0.665 0.881
LDL(mmol/L) 2.3±0.8 2.0±0.8 2.3±1.3 1.3(1.2，1.7) 4.193 0.241
HDL(mmol/L) 1.2±0.4 0.8±0.2 1.1±0.3 1.1±0.6 0.868 0.477
表3 四组凝血功能情况
指标 A组 B组 C组 功能良好组 χ2/F值 P值
PT(s) 12.9(12.2，22.8) 12.6±0.5 12.9±0.3 13.2(12.9，17.7) 4.304 0.230
APTT(s) 34.6±1.4 37.1±5.0 34.4±2.1 37.4(35.3，37.9) 2.484 0.478
D-d(mg/L) 0.7±0.7 0.5±0.3 0.7±0.2 0.64±0.5 0.202 0.893
表4 三试验组经溶栓治疗1月后导管情况
指标 A组 B组 C组 χ2/F值 P值
血流量(ml/min) 232.0±8.4ab 216.7±12.1 202.5±12.6 7.868 0.007
静脉压(mmHg) 178.8±14.9 176.3±13.3 190.8±12.7 1.429 0.278
动脉压(mmHg) -152.4±24.0c -160.2±13.7 -182.0±12.5 3.325 0.071
功能改善(例) 9d 6 2 9.915 0.008
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