| Purpose:Research the situations of catheter dysfunction of patients with chronic renal insufficiency uremia period of internal jugular vein catheter in different locking solutions (low molecular heparin and heparin), in order to provide scientific and reliable clinical evidence for proving whether low molecular heparin could be a new solution of locking catheter.Methods:Select the patients with chronic renal insufficiency uremia period doing blood dialysis treatment between March2012and August2012in blood purification center of Hunan province people’s hospital. All the patients were randomly divided into two groups, one is experimental group (low molecular heparin group, locking the catheter with low molecular heparin group), and the other is control group (heparin group, locking the catheter with heparin group). Investigate social demography of patients and a year of follow-up after hemodialysis treatment by using questionnaires, clinical observation, color doppler ultrasonic observation. Chi-square test, fisher’s exact probability method, t test and variance analysis were used to perform a statistical analysis,Results:(1) There were143patients with chronic renal insufficiency uremia period during March2012to August2012in Hunan province people’s hospital in blood purification center for blood dialysis treatment,140of them complied with the requirements of our research and agreed to participate in this study, the effective response rate was97.9%. Among them, the experimental group (low molecular heparin group) were78cases, and the control group (group heparin) were62cases.(2) In the experimental group:men accounted for43.6%while women accounted for56.4%, temporary and long-term catheter each accounted for37.2%and62.8%, single catheter patients accounted for23.1%, and the many times catheter patients accounted for76.9%; In control group:men accounted for46.7%while women accounted for53.2%, temporary and long-term catheter each accounted for40.3%and59.6%, single catheter patients accounted for21.0%, and the many times catheter patients accounted for79.0%; The difference of sex, types of catheter and catheter experience between the experimental group and control group was no statistical significance (P>0.05).(3) The average age of the experimental group was47.21±4.31years, and the control group average age was50.37±5.07, the age difference between the experimental group and control group was no statistical significance (P>0.05). The average experimental catheter days of the experimental group were87.21±24.55days, and the control group average experimental catheter days were90.37±25.07days, the average experimental catheter days difference between the experimental group and the control group was no statistical significance (P>0.05). The top three diseases in the experimental group were primary glomerulonephritis (41.0%), benign renal arteriolar sclerosis (20.5%) and diabetic nephropathy (20.5%), the top three diseases in the control group were primary glomerulonephritis (40.3%), benign renal arteriolar sclerosis (22.6%) and diabetic nephropathy (19.4%). Disease cases difference between the experimental group and control group was no statistical significance (P>0.05).(4) Two different locking fluid in the process of hemodialysis patients:(1) Tube plugging rate in the experimental group was19.2%, the control group was20.9%, the tube plugging rate of the two groups was no statistically significant difference (chi-square=2.786, P>2.786);(2) The average blood flow in the experimental group was223.5±19.1ml/min, the control group was222.7±18.7ml/min, the average blood flow of the two groups was no statistically significant difference (t=0.940, P>0.940);(5) The dialysis complications occurrence of two different locking fluid at the end of hemodialysis patients within7days:(1) the difference of puncture pressure point, time to turn occult blood, skin and mucosal bleeding stop time between the experimental group and control group was statistically significant (P<0.05), the experimental group puncture pressure time (5.6±1.54min), occult blood turn time (4.1±1.12d) and skin mucosa bleeding stop time (4.7±1.43d) are shorter than the control group (9.6±1.49min and8.6±1.71d,7.9±1.25d);(2) the experimental group and control group were repeatedly occurred the hemodialysis puncture, hematoma, local infection, catheter related infections and complications of catheter dysfunction, and the incidence of complications of experimental group and control group was9.0%(7/78) and14.5%(9/62). The complications situation difference between the experimental group and the control group was no statistically significant (chi-square=1.048, P>0.05).(6) The dialysis complications occurrence of patients of two different locking fluid after hemodialysis treatment within1year:(1) the experimental group and control group were repeatedly occurred hemodialysis puncture initial thickening, fibrin sheath, mural thrombus, intraductal thrombosis and vein stricture secondary change obviously, the incidence of complications of experimental group and control group was9.0%(7/78) and30.6%(19/62). The long-term complications situation difference between the experimental group and the control group was statistically significant (chi-square=10.727, P<0.05). In the experimental group, the fibrin sheath and intraductal thrombosis incidence were the highest, accounted for2.6%, in the control group the fibrin sheath incidence was the highest, accounted for9.7%;(2) the experimental group and control group were repeatedly occurred hemodialysis upper gastrointestinal bleeding, subcutaneous bleeding epistaxis and cerebral hemorrhage, the incidence of complications of experimental group and control group was13.5%(18/78) and58.1%(36/62). The incidence of bleeding difference between the experimental group and the control group was statistically significant (chi-square=17.846, P<0.05). In the experimental group, the epitasis incidence was the highest, accounted for6.4%, in the control group the subcutaneous bleeding incidence was the highest, accounted for29.0%.(7) The two different locking fluid in patients with hemodialysis related metabolic effects:(1) before hemodialysis treatment, the experimental group and control group of APTT and PT and PLT were no statistically significant difference (P>0.05). After hemodialysis treatment, the experimental group and control group the difference of APTT and PT and PLT were statistically significant (P<0.05), the experimental group of PLT (146±33×109/L) was higher than the control group (95±36×109/L), showing that the platelet reduce of experimental group was lower than the control group;(2) both before and after hemodialysis treatment, the experimental group and control group of HB and HCT were no statistically significant difference (P>0.05);(3) before hemodialysis treatment, the experimental group and control group TG, LDL and HDL-C concentration difference had no statistical significance (P>0.05). After dialysis, the experimental group and control group TG, LDL and HDL-C difference had statistical significance (P<0.05), the experimental group of TG (1.35±0.52mmol/L) and LDL-C(2.22±0.41mmol/L) were lower than the control group (2.26±0.41mmol/L,3.27±0.35mmol/L), the experimental group of HDL-C (1.77±0.33mmol/L) concentration was higher than the control group (1.25±0.43mmol/L), showed that after hemodialysis treatment, the experimental group of TG, LDL and HDL C were better than the control group.Conclusion:1. The effect of the low molecular heparin as a central venous catheter tube locking fluid in hemodialysis catheter jam, blood flow and was no difference with heparin.2. The low incidence of complications caused by hemodialysis of the molecular heparin as a hemodialysis center venous catheter tube locking fluid was lower than heparin and the effect of the low molecular heparin as a hemodialysis center venous catheter tube locking liquid on the body’s blood coagulation function and lipid metabolism was smaller than heparin. So we conclued that the effect of low molecular heparin as a hemodialysis center venous catheter tube locking fluid was better than heparin. |
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