早期应用尿激酶预防及治疗长期透析导管纤维蛋白鞘

目的探讨早期应用尿激酶预防及治疗长期透析导管纤维蛋白鞘的临床疗效及安全性。方法将38例置入长期中心静脉
导管且导管功能良好的血透患者，按随机化原则分为实验组和对照组，实验组于留置导管第3天开始应用尿激酶封管法及滴注
法；对照组于出现导管功能不良后，才开始使用上述方法；共观察6个月，比较两组患者在导管功能、透析平均血流量及静脉压、
凝血功能、副作用等方面有无差异。结果实验组及对照组导管动脉端功能不良的发生率分别为0.65%、2.71%（P<0.05），导管
静脉端功能不良的发生率分别为0.92%、2.14%（P<0.05）。实验组导管首次功能不良出现时间为87.9±24.1 d，对照组导管首次
功能不良出现时间为31.3±11.5 d（P<0.05）；置管1月后两组的平均血流量无明显差异（P>0.05），3月及6月后实验组平均血流量
大于对照组（P<0.05）；置管1月和3月后两组平均静脉压无明显差异（P>0.05），置管6月后实验组静脉压明显低于对照组（P<
0.05）；与对照组相比，实验组的凝血酶原时间延长（P<0.05），其余凝血指标无统计学差异；无严重药物副作用发生。结论早期
应用尿激酶预防及治疗长期透析导管纤维蛋白鞘疗效明显，副作用少，是一种安全有效的治疗方案。

Efficacy and safety of early use of urokinase for prevention and treatment of tunneled hemodialysis catheter-related fibrin sheaths

Objective To explore the clinical efficacy and safety of the early use of urokinase in the prevention and treatment on
tunneled hemodialysis catheter related fibrin sheaths. Methods Thirty-eight hemodialysis patients with tunneled central
venous catheter and good catheter function were randomly divided into experimental group and control group. Urokinase
was given after 3 days of indwelling catheter in the experimental group and after the onset of catheter dysfunction in the
control group. The catheter function, mean blood flow and venous pressure of dialysis, coagulation, and side effects in the two
groups were observed for 6 months. Results The rates of catheter dysfunction on the arterial side were 0.65% and 2.71% in the
experimental group and control group, respectively (P<0.05), with catheter dysfunction rates on the vein side of 0.92% and
2.41%, respectively (P<0.05). Catheter dysfunction occurred for the first time at 87.9±24.1 days in the experimental group, and
at 31.3±11.5 days in the control group (P<0.05). The mean blood flow showed no significant difference between the two groups
at 1 month after tube insertion (P>0.05), but was higher in the experimental group at 3 and 6 months after the tube insertion (P<
0.05). The mean venous pressure in two groups was similar 1 and 3 months after tube insertion (P>0.05), but was significantly
lower in the experimental group at 6 months (P<0.05). Compared with control group, the experimental group showed
significantly prolonged prothrombin time (P<0.05) but similar rest coagulation parameters. No serious drug-related side effects
occurred in these two groups. Conclusions Early use of urokinase is safe and effective for prevention and treatment of
tunneled hemodialysis catheter-related fibrin sheaths with minimal side effects.