| Background: Catheter thrombosis is one of the main reasons of catheter dysfunction and even extubation for hemodialysis patients. For preventing the catheter thrombosis, The Kidney Disease Outcomes Quality Initiative recommend to use the heparin locking solution to seal the catheter after dialysis. The clinical studies had found that the Activated Partial Thromboplastin Time was prolonged and the bleeding risk was increased after using the heparin locking solution in dialysis patients. Therefore, it is with great clinical significance to find a locking solution with a smaller influence on the Activated Partial Thromboplastin Time for the hemodialysis patients with high risk of bleeding, perioperative period and needing invasive manipulation. Urokinase has smaller effect on the body’s blood coagulation function, it was mainly used for catheter thrombolysis. Gabutti L found that the catheter flow was improved and the catheter dysfunction events were reduced after regular use of 5000U/ml urokinase catheter sealing,and considered urokinase as a better choice than 5000U/ml heparin. Studies showed that the D-dimer in the blood was associated with venous thrombosis.So is the D-dimer level in the blood around the catheter associated with catheter thrombosis?Rare researches were reported.Objective: By comparing the change of the Activated Partial Thromboplastin Time and Prothrombin Time in the peripheral blood after ten minutes of heparin and urokinase catheter sealing, and the change of the D-dimer level in the blood around the catheter just before catheter sealing, catheter sealing after one day and catheter sealing after two days,to analysis the risk of bleeding and catheter thrombosis after heparin and urokinase catheter sealing in hemodialysis patients.Method: Thirty hemodialysis patients with cuffed-catheters were selected from the blood purification center of Hunan Provincial People’s Hospital.All the patients were divided into two groups randomly,with 5000U/ml heparin and urokinase as sealing fluid respectively after dialysis. The data were collected including age, gender, dialysis time, catheter use time, dialysis frequency, basic diseases, dry weight, catheter flow, the APTT, PT, Fib, D-dimer, PLT, Hb, ALB, LDL, HDL, TG, TC and so on. For every patient, two ml of blood was drawn from the catheter after dialysis and before catheter sealing to detect the level of APTT, PT and Ddimer(the APTT, PT was also equal to the level in the peripheral blood). Two ml of blood was drawn from the peripheral blood to detect the APTT and PT level after ten minutes of catheter sealing.Two ml of blood was drawn through the catheter to detect the D-dimer level after one day and after two days of catheter sealing respectively. Observing the catheter flow, recording the cases of hemorrhage and the appearance of catheter fiber clot and catheter thrombolysis. When the catheter flow was less than 180 ml/min or the catheter fiber clot appeared, two ml of blood was drawn from the catheter to detect the D-dimer level and compared with that of catheter sealing and after two days of catheter sealing, used a high concentration of uroki-nase(50000U/ml) to seal the catheter for thrombolytic therapy at the same time.Result: 1. No statistical significance was found between the two groups of patients among age, sex, dialysis time, frequency of dialysis, basic disease, the dry weight, catheter flow and the general biochemical data(P > 0.05).2. No statistical significance was found in APTT、PT between the two groups just before catheter sealing(P1=0.945,P2=0.714). However, the statistical significance was found in APTT 、 PT between the two groups after ten minutes of catheter sealing(P1=0.034,P2=0.019). The APTT 、 PT level in heparin group were higher than that of urokinase group. 3. The APTT of heparin group was(11.37±10.39S)longer after ten minutes of catheter sealing than just before catheter sealing with statistical significance(P=0.001). The APTT of urokinase group after ten minutes of catheter sealing was no statistically significant compared with that of before(P= 0.33). The PT of heparin group was(5.58±6.46S)longer after ten minutes of catheter sealing than just before catheter sealing with statistical significance(P=0.005). The PT of urokinase group after ten minutes of catheter sealing was no statistically significant compared with that of before(P = 0.99). 4. For the heparin group, the D-dimer level of just before catheter sealing, after one day of catheter sealing and after two days of catheter sealing were(1.61±0.85)ug/ml,(1.79±0.85)ug/ml,(4.95± 5.46) ug/ml respectively. The D-dimer level after two days of catheter sealing was statistically significant compared with that of just before catheter sealing and after one day of catheter sealing(P0=0.007, P1=0.01). For the urokinase group, the D-dimer level of just before catheter sealing, after one day of catheter sealing and after two days of catheter sealing were(1.50±0.89)ug/ml,(1.81±0.98) ug/ml,(3.58± 2.74) ug/ml respectively.The D-dimer level after two days of catheter sealing was statistically significant compared with that of just before catheter sealing and after one day of catheter sealing(P0=0.002, P1=0.009). Between the heparin and urokinase group,no statistical significance were found just before catheter sealing, after one day of catheter sealing and after two days of catheter sealing(P0=0.714, P1= 0.961, P2= 0.394). 5. When the catheter dysfunction events happened, the D-dimer level was(6.25±5.40)ug/ml, which was higher than that of the same patients just before catheter sealing and after two days of catheter sealing(P0= 0.003, P2 = 0.025). 6. No statistical significance was found in Subcutaneous ecchymosis, bleeding gums, catheter fiber clot between the two groups, but statistical significance was found in thrombolytic therapy between the two groups(P=0.017). The cases of thrombolytic therapy in heparin group were more than urokinase group.Conclusion: 1. Compared with 5000U/ml urokinase locking solution, the patients’ potential bleeding risk is higher than using 5000U/ml heparin as locking solution after dialysis. 2. Compared with 5000U/ml heparin locking solution, 5000U/ml urokinase locking solution can reduce the cases of catheter thrombolytic therapy. 3. The D-dimer level in the blood around the catheter is closely related to catheter sealing time and catheter dysfunction events,it may be a early predictive factor of catheter thrombosis. |
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