摘要
目的选择不同剂量的尿激酶分别对血栓性中心静脉导管完全堵塞和部分阻塞的恶性肿瘤患者进行局部溶栓治疗,探讨尿激酶在静脉导管内溶栓的有效性与安全性,以指导临床护理实践。方法将62例血栓性中心静脉导管完全堵塞的患者随机分为观察组(A组,31例)和对照组(B组,31例),94例导管部分阻塞的患者分为观察组(C组,47例)和对照组(D组,47例)。A组以尿激酶(5 000 U/m l),采取持续“推-拉”注射器针栓的方法实施溶栓再通;B组以肝素盐水(1 2.5 U/m l)作为对照,限定操作时间为2 h。C组以与导管等容量的尿激酶液(2 000 U/m l),进行导管内留置,分别在保留药液后的15、30、45、60 m in抽出药液,评估导管是否复通;D组以同样的方法,采用肝素液(12.5 U/m l)进行对照,两组持续观察1 h。结果2 h内,A组30例(30/31,96.77%)复通,B组仅1例(1/31,3.23%)再通,两组比较差异非常显著(P<0.01)。在1 h内,C组40例(40/47,85.11%)复通,D组14例(14/47,29.79%)再通,两者间比较差异显著(P<0.05)。所有患者治疗后均未发现皮肤黏膜、消化道、泌尿系出血及血栓栓塞等情况。结论采用不同剂量尿激酶用于不同类型血栓性中心静脉导管溶栓,操作简单、成功率高,不良反应少。
Objective To determine whether the solution of different doses of urokinase could be used as a safe and effective therapeutic approach for restoring function of completely and partially occluded central venous access devices （OCVAD） in patients with cancer. Methods 62 patients with completely occluded catheter were divided into group A and group B. The patients in group A （ n = 31 ） were treated with urokinase solution（5 000 U/ml） and the other 31 cases in group B were treated with heparin saline solution （ 12.5 U/ml）by the ＂push-pull＂ technique. The procedure duration was 2 h. 94 patients with partially occluded catheter were divided into group C and group D. 47 cases in group C （observed group） were trea- ted with enough urokinase （2 000 U/ml） solution into a 1 ml syringe to equal the internal volume of the catheter. The solution was slowly and gently injected into the catheter and the function of OCVAD was evaluated at 15,30,45 and 60 min respectively after the instillation. The other 47 cases in group D （control group） were treated with heparin saline （ 12.5 U/ml） solution but the same procedure. Results Of the total 31 OCVAD of group A, 30（30/31,96.77% ） were successfully restored in 2 h;while in group B only 1 （ 1/31,3.23% ） OCVAD was successfully restored in 2 h. There was significant difference between the 2 groups （ P 〈0.01 ）. In group C and D, the restoration rate was 85.11% （40/47） and 29.79% （ 14/47 ） respectively. There was significant different between them （ P 〈 0.05 ）. There were no sideeffects, such as hemorrhage and thrombo-embolism in skin, mucosa, urinary system, in all groups. Conclusion The thrombolytic treatment using appropriate doses of urokinase to various types of occluded catheters is an effective and safe method in clearance of OCVAD.
出处
《解放军护理杂志》
2005年第10期1-3,共3页
Nursing Journal of Chinese People's Liberation Army
关键词
中心静脉导管
堵塞
尿激酶
溶栓
central venous catheter
occlusion
urokinase
thrombolysis
