华法令对于带涤纶套中央静脉导管功能不良的改善及临床分析

目的 观察口服华法令对于因血栓及纤维蛋白鞘而至涤纶套中央静脉导管置入后功能不良的改善并行临床分析.方法 59例带卡夫隧道导管患者,分为A组(28例)口服华法令1.5～3mg/d抗凝,对照组B组(31例)口服阿司匹林100mg/d抗凝,两组常规普通肝素封管.记录导管透析中血流量、回血静脉压,记录透析前后尿素氮、肌酐、超滤等,计算透析尿素清除指数,评估透析效果,定期检测非透析状态下国际标准化比值.比较导管留存时间、导管中位留存时间,并观察两组出血、导管相关性血流感染等并发症.观察一年时间.结果 A、B两组透析前后肌酐、尿素氮水平变化存在统计学差异,A组尿素清除指数均达标,A、B两组透析中血流量、回血静脉压比较存在统计学差异.A、B两组透析后比较肌酐、尿素氮水平、尿素清除指数以及国际标准化比值也存在统计学差异,且两组导管留存时间亦存在统计学差异.A组国际标准化比值维持在(2.00±0.93)之间,A、B两组未见出血、导管相关性血流感染并发症.结论 带卡夫中央静脉导管置后常规口服中等剂量华法令抗凝配合肝素封管较口服阿司匹林更能改善因血栓及纤维蛋白鞘而至导管功能不良,延长导管留存时间,且并发症少.但本研究样本量偏少,观察时间偏短,仍需进一步临床验证以证实口服华法令在带卡夫隧道导管置入后临床安全性及有效性.

Warfarin for improvement the cuffed central venous catheter dysfunction and clinical analysis

Objectives To observe the improvement of warfarin for cuffed central venous catheter dysfunction due to thrombus and fibrin sheath and to carry on the clinical analysis.Methods 59 patients with cuffed central venous catheter were divided into group A (28 cases) and control group B (31 cases),patients in the group A were given warfarin 1.5 ～3mg/d,and patients in the control group B were given aspirin 100mg/d.The heparin was used to sealed tube in two groups.Catheter hemodialysis blood flow,blood return venous pressure in hemodialysis and the blood urea nitrogen and creatinine,ultrafiltration before and after dialysis,urea clearance index (Kt/V) and the effect of dialysis were recorded and evaluated.Non dialysis state international normalized ratio(INR) was regularly detected.Catheter retention time and median retention time,bleeding,catheter related blood stream infection and other complications were compared between the two groups in a year.Results There were statistical differences in level of creatinine and urea nitrogen between group A and B before and after dialysis.Urea clearance index of group A was standard.There were statistical differences in blood flow and vein blood pressure in dialysis between two groups.There were also statistical differences in level of creatinine and urea nitrogen,urea clearance index and INR after dialysis between group A and group B.And there was also statistical difference in retention time of the two groups.Bleeding,complications of catheter related blood stream infection were not found in group A and B.Conclusions After cuffed central venous catheter placement,taking moderate dose warfarin with heparin sealed tube is better than aspirin,which would improve catheter dysfunctiondue due to thrombus and fibrin sheath and prolong catheter retention time with few complications.But the study is fairly small,and the observation time is short.It should be further studied in clinic to confirm clinical safety and efficacy of warfarin after cuffed central venous catheter placement.