CAJ | 학술논문

目的使用尿激酶持续泵入法与常规封管溶栓法对深静脉置管功能不良的疗效比较,以期解决局部尿激酶溶栓疗效不佳、易复发的局限性。方法选择2010年1月至2013年12月在解放军第401医院使用深静脉留置导管进行血液透析治疗,临床诊断导管功能不良的42例患者随机分为A组和B组,每组21例。A组使用10万单位尿激酶溶入生理盐水50 ml,持续微量泵2 h泵入动静脉端；B组使用10万单位尿激酶溶于4 ml生理盐水中动静脉端局部封管2 h,比较2组溶栓疗效及凝血指标。结果 A组溶栓后通畅率95.2%,平均血流量(232.0±22.4)ml/min。B组溶栓后通畅率90.5%,平均血流量(219±25.0)ml/min。2组溶栓后通畅率及血流量差异均无统计学意义(P>0.05)。溶栓成功后15 d,A组通畅率85.7%,B组通畅率61.9%；2组患者通畅率差异有统计学意义。其中 A组患者溶栓当天及溶栓第15天后导管功能良好率无统计学差异(P>0.05),但B组患者溶栓当天及溶栓后第15天导管功能良好率有统计学差异(P<0.05)。2组患者未出现出血、发热、皮疹、过敏等明显的不良反应。结论尿激酶持续泵入法比局部封管溶栓法治疗成功率高,15 d 后通畅率高,无明显不良反应。
목적사용뇨격매지속빙입법여상규봉관용전법대심정맥치관공능불량적료효비교,이기해결국부뇨격매용전료효불가、역복발적국한성。방법선택2010년1월지2013년12월재해방군제401의원사용심정맥류치도관진행혈액투석치료,림상진단도관공능불량적42례환자수궤분위A조화B조,매조21례。A조사용10만단위뇨격매용입생리염수50 ml,지속미량빙2 h빙입동정맥단；B조사용10만단위뇨격매용우4 ml생리염수중동정맥단국부봉관2 h,비교2조용전료효급응혈지표。결과 A조용전후통창솔95.2%,평균혈류량(232.0±22.4)ml/min。B조용전후통창솔90.5%,평균혈류량(219±25.0)ml/min。2조용전후통창솔급혈류량차이균무통계학의의(P>0.05)。용전성공후15 d,A조통창솔85.7%,B조통창솔61.9%；2조환자통창솔차이유통계학의의。기중 A조환자용전당천급용전제15천후도관공능량호솔무통계학차이(P>0.05),단B조환자용전당천급용전후제15천도관공능량호솔유통계학차이(P<0.05)。2조환자미출현출혈、발열、피진、과민등명현적불량반응。결론뇨격매지속빙입법비국부봉관용전법치료성공솔고,15 d 후통창솔고,무명현불량반응。
Objective Tocomparetheefficacyandsafetyofcontinuousmicropumpvs.conven-tional sealed tube in the treatment of patients with late dysfunction of deep venous catheter,and to solvethelimitationofconventionalsealedtube.Methods Clinicaldatawerecollectedfrom42patients with late dysfunction of deep venous catheter who were treated with hemodialysis treatment because of uremia from January 2010 to August 2013.These patients were randomly assigned to group A and group B.The patients in group A were treated with continuous micro pump using 1 00 000 U of uroki-nase dissolved in 50 mL saline for 2 h,and those in group B were treated with conventional sealed tube using 1 00 000 U of urokinase dissolved in 4 mL saline.The thrombolysis and recanalization rate was assessedandcomparedbetweenthetwogroupsafterthetreatmentfor2weeks.Results Therateof thrombolysis and recanalization in groups A and B was 95.2% and 90.5% respectively (P>0.05). After 2 weeks,the rate of thrombolysis and recanalization in groups A and B was 85.7% and 61.9%respectively (P<0.05).No side effects of bleeding and OB,etc occurred in both two groups.Conclu-sions Ascomparewiththeconventionalsealedtube,theuseofcontinuousmicropumptreatmentsig-nificantly increase the rate of thrombolysis and recanalization at 2nd week post-thrombosis in the pa-tients with late dysfunction of deep venous catheter.