Bevilacqua José Luís, Gomes Jaelson Guilhem, Santos Vanderson Farley Brito, Canziani Maria Eugênia Fernandes
Instituto de Hemodiálise Sorocaba – IHS, State of São Paulo, Brazil.
J Bras Nefrol. 2011 Mar;33(1):86-92.
The high incidence of patients beginning dialysis treatment with venous catheters, as well as the growing number of patients with permanent catheter access, has increased catheter- related blood infections and their consequences. Thus the search for substances with anticoagulant properties that also prevent catheter contamination is necessary.
This study aimed at comparing heparin and trisodium citrate used as long-term catheter locking solutions regarding the occurrence of pyrogenic reaction, bacteremia, infection- related hospitalizations, thrombosis, and death.
Retrospective study on the infection data from the Infection and Adverse Event Prevention Control Program registry, which included all hemodialysis patients using long-term catheters from April, 2006 to March, 2008. During the first 365 days, catheters were locked with heparin (Heparin group) and, during the following 365 days, with 46.7% trisodium citrate (Citrate group). Sixty-five patients were included in the study using 92 catheters. The groups were compared regarding the occurrence of pyrogenic reaction, bacteremia, hospitalization, catheter thrombosis, and death.
The catheter-related bacteremia episodes were significantly lower and hospitalization time was significantly shorter in the Citrate group when compared with those in the Heparin group. A tendency towards a lower occurrence of access site infection-related hospitalization was observed in the Citrate group (p = 0.055), and no difference was observed in catheter thrombosis leading to dysfunction between groups. Bacteremia-free and hospitalization-free times were longer in the Citrate group. The occurrence of bacteremia was associated with the presence of diabetes and heparin use. In multivariate analysis, being in the Heparin group was the only factor associated with bacteremia.
The use of 46.7% citrate solution effectively reduced bacteremia episodes and hospitalization in chronic kidney disease patients on hemodialysis with long-term catheters.
开始接受透析治疗时使用静脉导管的患者比例较高，以及永久性导管通路患者数量不断增加，导致与导管相关的血液感染及其后果有所增加。因此，有必要寻找具有抗凝特性且能防止导管污染的物质。
本研究旨在比较用作长期导管封管溶液的肝素和枸橼酸钠在发热反应、菌血症、感染相关住院、血栓形成及死亡发生率方面的差异。
对感染与不良事件预防控制项目登记处的感染数据进行回顾性研究，该登记处纳入了2006年4月至2008年3月期间所有使用长期导管的血液透析患者。在最初的365天内，导管用肝素封管（肝素组），在随后的365天内，用46.7%枸橼酸钠封管（枸橼酸钠组）。本研究共纳入65例患者，使用了92根导管。比较两组在发热反应、菌血症、住院、导管血栓形成及死亡发生率方面的差异。
与肝素组相比，枸橼酸钠组的导管相关菌血症发作次数显著降低，住院时间显著缩短。枸橼酸钠组观察到与穿刺部位感染相关住院发生率有降低趋势（p = 0.055），两组之间因导管血栓形成导致功能障碍方面未观察到差异。枸橼酸钠组无菌血症和无住院时间更长。菌血症的发生与糖尿病的存在及肝素的使用有关。在多变量分析中，处于肝素组是与菌血症相关的唯一因素。
对于接受血液透析且使用长期导管的慢性肾病患者，使用46.7%枸橼酸钠溶液可有效减少菌血症发作次数和住院率。
