早期尿激酶封管对防治长期透析患者导管纤维蛋白鞘形成的应用效果观察

Abstract
Figure/Table
References
Related Citation (3)

Download: PDF (2190 KB) HTML (1 KB)
Export: BibTeX | EndNote (RIS)

Abstract Objective To observe the effect of early urokinase sealing in preventing the formation of catheter fibrin sheath in long-term hemodialysis patients. Methods From February 2021 to February 2022,46 patients were selected for regular hemodialysis treatment in the hemodialysis room and nephrology department of our hospital. The patients were divided into two groups. In the urokinase group,23 patients began to receive urokinase tube sealing treatment at the time of the first dialysis treatment,while in the conventional group,23 patients only received conventional heparin tube sealing treatment at the time of the first dialysis treatment,and urokinase therapy was started only after the patient's catheter was dysfunctional. The occurrence of catheter dysfunction,the change of coagulation function index before and after treatment,the change of catheter blood flow and venous pressure during treatment and the occurrence of adverse reactions were compared between the two groups. Results The occurrence of catheter dysfunction in the urokinase group was much lower than that in the conventional group,and the average time of the first occurrence of catheter dysfunction in the urokinase group was later than that in the conventional group. At 6 months of dialysis,there was no significant difference in APTT,TT and Fib levels between the two groups,but the average PT time of the urokinase group was significantly longer than that of the conventional group. There was no significant difference in the mean catheter blood flow and venous pressure between the two groups at 1 month of dialysis. At 3 and 6 months of dialysis,the average blood flow in the urokinase group was significantly higher than that in the conventional group,while the venous pressure was significantly lower than that in the conventional group. Neither urokinase group nor routine group had any serious adverse reactions that needed to stop treatment,no gastrointestinal bleeding,serious liver injury and other drug toxicity. Conclusion In patients who need long-term catheterization for hemodialysis treatment,early urokinase sealing measures can better prevent the formation of fibrin sheath in the catheter,prolong the service life of the catheter,and have high safety.

Key words： long-term hemodialysis indwelling catheter fibrin sheath urokinase sealing

Received: 12 September 2023

PACS:

R692.5

	Service

	E-mail this article
	Add to my bookshelf
	Add to citation manager
	E-mail Alert
	RSS
	Articles by authors
	LIANG Yu
	LIU Huanhao
	MAI Haiyan
	HUANG Yu
	LIANG Jinyue

Cite this article:

LIANG Yu,LIU Huanhao,MAI Haiyan等. Effect of Early Urokinase Sealing on Orevention and Treatment of Catheter Fibrin Sheath Formation in Long-term Hemodialysis Patients[J]. HuNan ShiFan DaXue XueBao(YiXueBan), 2024, 21(1): 85-89.

URL:

http://yxb.hunnu.edu.cn/EN/ OR http://yxb.hunnu.edu.cn/EN/Y2024/V21/I1/85

[1] 尚春娥,刘冬梅,师璟,等. 血液透析串联不同时机血液灌流在维持性血液透析病人中的应用[J]. 护理研究,2023,37(4):746-749.
[2] 达静静,孙月,陈金春,等. 血液灌流对维持性血液透析患者蛋白质能量消耗及长期预后的影响[J]. 中华医学杂志,2023,103(8):559-565.
[3] 华青,陈强,王红梅,等. 生物自动反馈式血容量监测模式干预血液透析中低血压对维持性血液透析患者心功能的影响[J]. 中国医师杂志,2022,24(4):551-555.
[4] RAINA R,JOSHI H,CHAKRABORTY R,et al.Challenges of long-term vascular access in pediatric hemodialysis:Recommendations for practitioners[J]. Hemodial Int,2021,25(1):3-11.
[5] SADEGHI M,BEHDAD S,SHAHSANAEI F.Infective Endocarditis and Its Short and Long-Term Prognosis in Hemodialysis Patients:A Systematic Review and Meta-analysis[J]. Curr Probl Cardiol,2021,46(3):100680.
[6] NI N,MOJIBIAN H,POLLAK J,et al.Association between disruption of fibrin sheaths using percutaneous transluminal angioplasty balloons and late onset of central venous stenosis[J]. Cardiovasc Intervent Radiol,2011,34(1):114-119.
[7] 张敏,高俊芳,陈晓琳,等. PICC相关纤维蛋白鞘研究进展[J]. 齐鲁护理杂志,2019,25(1):106-109.
[8] NEWMAN J,SYED A,BLIVAISS C,et al.Calcified Catheter-Related Fibrin Sheath Forms Large Intravenous Cast in Hemodialysis Patient Causing Embolic Sequelae[J]. Cureus,2022,14(11):e31714.
[9] CHANG DH,MAMMADOV K,HICKETHIER T,et al.Fibrin sheaths in central venous port catheters:treatment with low-dose,single injection of urokinase on an outpatient basis[J]. Ther Clin Risk Manag,2017,13:111-115.
[10] 奚璐,张超琅,潘玲丽. 静脉泵注尿激酶在白血病儿童TIAP尖端纤维蛋白鞘形成后成功应用1例[J]. 浙江医学,2022,44(17):1883-1884.
[11] 卢艺怡,吴秀清,郭军军,等. 应用失效模式与效应分析预防透析导管功能不良[J]. 国际医药卫生导报,2017,23(14):2272-2275.
[12] 叶有新. 长期血液透析径路[J]. 临床肾脏病杂志,2012,12(7):297-298.
[13] WETMORE JB,HERZOG CA,YAN H,et al.Apixaban versus Warfarin for Treatment of Venous Thromboembolism in Patients Receiving Long-Term Dialysis[J]. Clin J Am Soc Nephrol,2022,17(5):693-702.
[14] RUIKKA JL,ACUN C,KARNATI S.Entrapped peripherally inserted central catheter due to fibrin sheath in a neonate with noninvasive extraction and review of literature[J]. J Neonatal Perinatal Med,2022,15(2):383-386.
[15] 段青青,张丽红,王保兴. 中心静脉导管纤维蛋白鞘的组织病理学特点及发生机制的研究进展[J]. 中国血液净化,2011,10(9):503-506.
[16] ALFANO D,FRANCO P,STOPPELLI MP.Modulation of Cellular Function by the Urokinase Receptor Signalling:A Mechanistic View[J]. Front Cell Dev Biol,2022,10:818616.
[17] 李小庭,刘丁,王亚彬,等. 早期应用尿激酶预防及治疗长期透析导管纤维蛋白鞘[J]. 南方医科大学学报,2014(11):1668-1671.
[18] GRAY RJ,LEVITIN A,BUCK D,et al.Percutaneous fibrin sheath stripping versus transcatheter urokinase infusion for malfunctioning well-positioned tunneled central venous dialysis catheters:a prospective,randomized trial[J]. J Vasc Interv Radiol,2000,11(9):1121-1129.
[19] LI X,LIU D,WANG Y,et al. [Efficacy and safety of early use of urokinase for prevention and treatment of tunneled hemodialysis catheter-related fibrin sheaths][J]. Nan Fang Yi Ke Da Xue Xue Bao,2014,34(11):1668-1671. Chinese.
[20] 刘晓丽,李桂英,王晓英,等. 早期尿激酶应用对慢性肾衰竭静脉置管长期血液透析患者导管纤维蛋白鞘形成防治效果研究[J]. 临床误诊误治,2020,33(4):52-56.