尿激酶持续泵入治疗长期留置血液透析导管功能障碍

目的探讨大剂量尿激酶持续泵入联合低分子肝素治疗维持性血液透析患者留置导管功能障碍的临床疗效。方法选取有导管功能障碍的患者18例，分成常规尿激酶治疗组（A组）10例；大剂量尿激酶联合低分子肝素治疗组（B组）8例，前者按K／DOQI推荐的尿激酶溶栓方案进行处理，后者则采用大剂量尿激酶持续泵入溶栓治疗，并后续给予低分子肝素，观察2组患者留置导管溶栓后再通率、复通后血流量、凝血指标等。结果A组患者行溶栓治疗56例次，溶栓后导管再通率71．4％，复通后血流量（198±32）ml／min；B组患者行溶栓治疗32例次，溶栓后导管再通率100％，复通后血流量（252±28）ml／min，2组患者导管再通率和复通后血流量均有统计学差异（P〈0．05）。2组患者各凝血指标无显著差异（P〉0．05）。结论大剂量尿激酶持续泵入联合低分子肝素治疗维持性血液透析患者长期留置导管功能障碍，再通率高，安全性好。

The efficacy of urokinase continuous pump infusion in the treatment of long-term hemodialysis catheter dysfunction

Objective To explore the clinical efficacy of high-dose urokinase and low molecular weight heparin in the treatment of maintenance hemodialysis patients with cuffed catheter dysfunction. Methods Eighteen maintenance hemodialysis patients with catheter dysfunction were randomly divided into conventional group （group A） and highdose group （group B）. The patients in group A were dealt with urokinase according to the standard program recommended by K/I）OQI, and those in group B received high-dose urokinase continuous pump infusion, and during the follow-up period low-molecular-weight heparin was given. The catheter recanalization rate, blood flow after the resumption and coagulation indexes were observed. Results The patients in group A were treated by 56 times, the recanalization rate was 71.4%,and blood flow was （198 ± 32）ml/min, and those in group B were treated by 32 times,the recanalization rate was 100% ,and blood flow was （252 ± 28）ml/min. There were very significant difference in catheter recanalization rate and blood flow after the resumption between two groups,but no significant difference in coagulation indexes was found. Conclusions The therapy of high-dose urokinase continuous pump infusion into the catheter combined with low-molecular-weight heparin in hemodialysis patients with cuffed catheter dysfunction is safe and can obtain high recanalization rate.