CAJ | 학술논문

目的比较尿激酶、华法林、阿司匹林防治血液透析患者中心静脉半永久性留置导管功能不良的效果及安全性.方法选取南京大学医学院附属鼓楼医院肾科2009年1月至2014年12月经中心静脉半永久性留置导管行规律血液透析的慢性肾衰竭患者72例,按给予的抗血栓药物将患者分为尿激酶组16例、华法林组20例、阿司匹林组17例与对照组19例.对照组给予常规肝素封管;尿激酶组在对照组治疗的基础上每周尿激酶10万U封管1次,每4个月予以尿激酶25万U导管内滴入1次;华法林组、阿司匹林组在对照组治疗基础上分别给予口服华法林片、阿司匹林肠溶片.比较4组患者在6个月的透析过程中导管功能不良发生率、尿素清除指数(KT/Vurea)增加值、凝血功能障碍相关事件、导管相关感染等情况.结果尿激酶组、华法林组、阿司匹林组导管功能不良发生率分别为15.96％、17.38％、22.87％,与对照组(46.96％)比较差异均有统计学意义(P均＜0.05);尿激酶组、华法林组、阿司匹林组、对照组的KT/Vurea增加值分别为0.11±0.07、0.09±0.06、0.06±0.05、-0.05±0.04,4组比较差异有统计学意义(F=3.18,P＜0.05).4组患者出血事件发生率及治疗前、后凝血功能比较差异均无统计学意义(P均＞0.05).结论尿激酶、华法林和阿司匹林均可用于防治慢性肾衰竭患者的导管血栓形成,可显著降低半永久性留置导管功能不良发生率,提高透析充分性,不增加凝血功能障碍相关事件.尿激酶和华法林的疗效优于阿司匹林.
목적 비교뇨격매、화법림、아사필림방치혈액투석환자중심정맥반영구성류치도관공능불량적효과급안전성.방법 선취남경대학의학원부속고루의원신과2009년1월지2014년12월경중심정맥반영구성류치도관행규률혈액투석적만성신쇠갈환자72례,안급여적항혈전약물장환자분위뇨격매조16례、화법림조20례、아사필림조17례여대조조19례.대조조급여상규간소봉관;뇨격매조재대조조치료적기출상매주뇨격매10만U봉관1차,매4개월여이뇨격매25만U도관내적입1차;화법림조、아사필림조재대조조치료기출상분별급여구복화법림편、아사필림장용편.비교4조환자재6개월적투석과정중도관공능불량발생솔、뇨소청제지수(KT/Vurea)증가치、응혈공능장애상관사건、도관상관감염등정황.결과 뇨격매조、화법림조、아사필림조도관공능불량발생솔분별위15.96％、17.38％、22.87％,여대조조(46.96％)비교차이균유통계학의의(P균＜0.05);뇨격매조、화법림조、아사필림조、대조조적KT/Vurea증가치분별위0.11±0.07、0.09±0.06、0.06±0.05、-0.05±0.04,4조비교차이유통계학의의(F=3.18,P＜0.05).4조환자출혈사건발생솔급치료전、후응혈공능비교차이균무통계학의의(P균＞0.05).결론 뇨격매、화법림화아사필림균가용우방치만성신쇠갈환자적도관혈전형성,가현저강저반영구성류치도관공능불량발생솔,제고투석충분성,불증가응혈공능장애상관사건.뇨격매화화법림적료효우우아사필림.
Objective To compare the efficacy and safety of urokinase,warfarin and aspirin in the prevention the dysfunction of central venous cuffed catheter in hemodialysis (HD) patients.Methods There were 72 HD patients who from Janurary 2009 to December 2014 with cuffed dual lumen catheter in the Drum Tower Hospital Affiliated to Nanjing University Medical School were randomly divided into urokinase group (n =16),warfarin group(n=20),aspirin group(n=17) and the control group(n=19).The control group received conventional heparin lock.The urokinase group was sealed with urokinase 100,000 units weekly and urokinase 250,000 units every 4 months.The warfarin and aspirin group took adjusted doses of warfarin and aspirin.The incidence of catheter dysfunction and catheter-related infections,the increasing value of urea clearance index (KT/Vurea) and the incidence of bleeding events were observed in four groups six months during hemodialysis.Results The incidence of catheter dysfunction in the urokinase group,warfarin,aspirin group and control group were 15.96％,17.38％,22.87％ and 46.96％ respectively,and the differences among the four groups were significant (P ＜ 0.05).The increasing value of KT/Vurea were 0.11 ± 0.07,0.09 ± 0.06,0.06 ±0.05,-0.05±0.04 in the urokinase group,warfarin,aspirin group and control group,and the differences were significant(F=3.18,P＜0.05).The incidence of bleeding events before and after the treatment of coagulation was not significantly different (P ＞ 0.05).Conclusion Urokinase,warfarin and aspirin can be used for prevention and treatment of hemodialysis adverse long-term indwelling catheter function,and improve dialysis adequacy,without increasing coagulopathy related events.Urokinase and warfarin are more effective than aspirin.