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目的探讨70%乙醇封管对预防维持性血液透析带隧道带涤纶套(Cuff)导管患者导管相关性血流感染(catheter related blood stream infection,CRBSI)的有效性和安全性。方法本试验采用随机自身交叉对照方法。选择东南大学附属中大医院肾脏科维持性血液透析患者32例,首先将患者随机分为乙醇封管组(每周采用3.3mL 70%乙醇封管1次,再采用3.3mL标准肝素封管2次)和肝素封管组(每周采用3.3mL标准肝素封管3次),每组16例,22周后进行交叉互换。比较两组患者CRBSI、导管功能障碍和其他不良反应的发生率。结果 2例患者退出试验,2例死亡,共28例患者完成试验,每组各14例。乙醇封管组患者CRBSI的发生率为0.45/1 000导管日,低于肝素封管组患者(0.92/1 000导管日),但差异无统计学意义(P>0.05)。乙醇封管组患者导管功能障碍的发生率为0.90/1 000导管日,低于肝素封管组(2.06/1 000导管日),但差异无统计学意义(P>0.05)。两组患者的血常规、肝功能、凝血功能差异无统计学意义。乙醇封管组患者均未发生恶心、呕吐、头晕等不良反应。结论乙醇封管组维持性血液透析带隧道带Cuff导管患者的CRBSI发生率呈下降趋势,但与肝素封管组相比差异无统计学意义。
Objective To investigate the efficacy and safety of 70% ethanol occlusion in the prevention of catheter-related bloodstream infection (CRBSI) in patients with dacron-cuffed conduit undergoing maintenance hemodialysis. Methods This experiment using random self-cross-control method. Thirty-two patients with nephrology who underwent maintenance hemodialysis at the Affiliated Zhongda Hospital of Southeast University were randomly divided into three groups: Times) and heparin occlusion group (3.3mL standard heparin weekly occlusion tube 3 times), each group of 16 cases, 22 weeks after the cross-exchange. The incidence of CRBSI, catheter dysfunction, and other adverse events was compared between the two groups. Results Two patients withdrew from the trial and two died. A total of 28 patients completed the trial, 14 in each group. The incidence of CRBSI was 0.45 / 1,000 catheter days in patients in the ethanol occlusion group, which was lower than that in the heparin occlusion group (0.92 / 1,000 catheter days), but the difference was not statistically significant (P> 0.05). The incidence of catheter dysfunction was 0.90 / 1,000 catheter days in patients in the ethanol occlusion group, which was lower than that in the heparin occlusion group (2.06 / 1,000 catheter days), but the difference was not statistically significant (P> 0.05). The two groups of patients with blood, liver function, coagulation differences were not statistically significant. Patients in the sealed ethanol group had no nausea, vomiting, dizziness and other adverse reactions. Conclusions The incidence of CRBSI in patients undergoing elective heparin occlusion in tunnels with ethanol-occluded hemodialysis has a decreasing trend, but there is no significant difference compared with heparin occlusive group.