- 學位論文
尿激酶對於長期血液透析導管阻塞治療之療效研究
Efficacy of Urokinase on Occlusion of Permcath
摘要
緣由︰ 長期血液透析導管阻塞是血液透析病患長期照顧中常見的困擾。使用血栓溶解劑治療，是一項有效的治療方式，但因劑量及給藥方式不同，而治療結果也眾說紛紜。 方法： 本研究是採回顧式收錄國軍高雄總醫院血液透析中心病患之研究。自2004年1月1日至2010年12月31日，收錄使用長期血液透析導管進行血液透析之病患發生阻塞者，這些患者已植入長期血液透析導管一週以上，觀察高劑量尿激酶250,000單位經由血液透析導管內靜脈，滴注24小時。紀錄病患之基本資料、導管挽救成功率、使用血栓溶解劑之初通時間、次通時間、治療期間之藥物併發症。 結果： 本研究從2004至2010年於國軍高雄總醫院之血液透析病患中，收集曾經使用長期血液透析導管進行血液透析者共1,314人次，發生管路阻塞者共82人次，使用尿激酶溶栓一或多次治療者為61人次。完全阻塞後使用高劑量尿激酶長時滴注組治療後全部恢復暢通。平均初通時間為241.3±218.8 (8-891) 天，平均次通時間為122.4±166.6 (15- 610) 天。且在治療期間無嚴重出血性併發症發生。 結論： 使用經導管輸注尿激酶250,000單位24小時，治療阻塞的長期血液透析導管是有效之治療模式。
並列摘要
Purpose: Occlusion of permcath is the major problem in long-term care of end stage renal disease patients. Thrombolytic therapy is an option to treat occlusion of permcath, but comparison with different modalities of administration would be warranted. Methods: A retrospective cohort study was conducted at Kaohsiung Armed Forces General Hospital from January 1st, 2004 to December 31st, 2010. The patients who suffered from occlusion of permcath at least 1 week after indwelling permcath were enrolled into the study. Anyone who underwent urokinase 250,000 iu transcatheter infusion for 24 hours was enrolled to our study. The patient’s general data, results of patency and duration of primary patency were reviewed. Results: 1,314 permcath were inserted for our hemodialysis service from 2004 to 2010. 82 of these catheters developed total thrombosis during this time and urokinase was used to restore patency one or more times – total 61 treatments. The permcaths could be recanalized after thrombolytic therapy and the primary patency was 241.3±218.8 (8-891) days; the secondary patency was 122.4±166.6 (15-610) days. No bleeding adverse events occurred. Conclusion: Transcatheter infusion for 24 hours with urokinase 250,000 iu via permcath is an acceptable option of permcath care.