摘要目的 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.

abstractsObjective 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.