| Objective To explore the effect of urokinase sealing on central venous catheter-related blood flow infection,to make sure that urokinase sealing can reduce the effectiveness of central venous catheter-related blood flow infection and the appropriate sealing time,and to explore the safety of urokinase sealing through the influence of coagulation index,in order to obtain clinical practical prevention of central venous catheter-related blood flow infection through specific urokinase sealing operation methods.Methods From Oct 2016 to Dec 2019,patients undergoing blood purification therapy in ICU of our hospital were collected,all of them were kept with right internal jugular vein double-lumen catheters.They were randomly divided into control group,urokinase sealing for 30 minutes and urokinase sealing for 60 minutes.The general conditions of patients,such as gender,age,primary diseases,catheter indwelling days were recorded,and the condition was evaluated.In the urokinase sealing group,internal jugular vein double-lumen catheter was sealed once a week.0.6 ml 25 000 u/ml urokinase was injected into the main tube of the catheter and 0.4ml into the accessory tube of the catheter.The catheter was temporarily sealing for 30 minutes and 60 minutes respectively.The control group was sealed with saline for 30 minutes.Blood samples were collected24 hours after sealing for routine blood coagulation test,blood routine test,procalcitonin(PCT)and C-reactive protein(CRP).Blood coagulation indexes were recorded: platelet count(PLT),international standard ratio of prothrombin time(PT-INR),activated partial thromboplastin time ratio(APTT-R),fibrinogen(FIB),and related infection indexes,such as WBC,CRP,PCT.The catheter-related blood flow infection index and bleeding events were observed every day,and the rates of infection and bleeding of each group were counted.Statistical software SPSS 21.0 was used for data processing and analysis.Results After strict inclusion and exclusion criteria screening,213 cases were included in the study,including 109 males and 104 females,aged 29-91 years,with an average age of(61.29 + 12.5)years.The baseline data of the three groups were identical,and there was no significant difference in gender,age,primary disease,catheter indwelling days and condition assessment(P > 0.05).In the control group,there were 6 patients with central venous related bloodstream infection,and 2 patients in the 30-minute group and the60-minute group with urokinase closure.In terms of infection rate,the 30-minute group and the 60-minute group were lower than the control group,the difference was statistically significant(?~2 = 4.604/4.602,P =0.032).There was no significant difference between the 30-minute group and the 60-minute group(?~2 =0.001,P> 0.05).There was a total of 28 patients in the urokinase solution sealing group for 30 minutes,the 60 minutes group and the control group.The bleeding rate in the three groups was 12.86%,11.11%and 15.49%,respectively,with no statistically significant difference(?~2 = 2.066,P> 0.05).There were also no significant changes in platelet count,international standard ratio of prothrombin time,activated partial thromboplastin time ratio and fibrinogen in urokinase group before and after the experiment,all P > 0.05.There were statistical differences in WBC,CRP and PCT results among the three groups before and after intervention,F > F critical value.Conclusion Urokinase sealing can prevent catheter-related bloodstream infection.For double-lumen catheter in internal jugular vein of ICU patients,urokinase is probably effective for 30 minutes without long-term catheter closure.Urokinase tube sealing is safe and effective,without any side-effect on coagulation index and bleeding events in patients. |
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