目的探讨定期应用重组组织纤溶酶原激活剂(recombinant tissue plasminogen activator，rt-PA)预防带隧道带涤纶套导管(tunneled cuffed catheter,TCC)阻塞的效果。方法将62 例维持性血液透析患者随机分为：常规组、尿激酶组和rt-PA 组。3 组间进行两两比较，对比分析每次透析前抽吸不畅发生率、透析中需干预事件的发生率、透析血流量、透析静脉压、并发症(出血、感染)情况等。结果在透析前抽吸不畅发生率、透析中需干预事件发生率、透析静脉压方面，rt-PA 组低于尿激
酶组[分别为5.1%比10.7%，χ2=58.643，P=0.000；5.8%比11.0%，χ2=48.027，P=0.000；(113.0±14.1)mmHg比(123.0±14.4)mmHg，q=3.154，P=0.037]和常规组[分别为5.1%比13.7%，χ2=115.387，P=0.000；5.8%比17.8%，χ2=187.411，P=0.000；(113.0±14.1)mmHg 比(135.2±15.1)mmHg，q=6.854，P=0.005]，尿激酶组亦分别低于常规组(P＜0.05)。rt- PA 组透析血流量大于尿激酶组[(248.1±14.9)ml/min 比(239.1±14.2)ml/min，q＝2.906，P=0.042]和常规组[(248.1±14.9)ml/min 比(227.9±13.4)ml/min,q＝6.378，P=0.006]，尿激酶组大于常规组(q＝3.508，P=0.032)。3 组间在发生出血(χ2=0.233，P=0.890)、感染并发症(χ2= 1.541，P=0.463)方面差异无统计学意义。结论在应用肝素常规封管的基础上定期给予rt-PA封管，可以安全、有效地预防TCC阻塞，增加透析血流量。

Objective To explore the clinical effect of recombinant tissue plasminogen activator (rt-PA) on the prevention of thrombokinesis in tunneled cuffed catheter (TCC). Methods A total of 62 cases of maintenance hemodialysis patients were randomly divided into control group, urokinase group, and rt- PA group. The difficulties of blood access before dialysis, the intervention rate during dialysis, blood flow volume, venous pressure, and other complications were compared among the 3 groups. Results The difficulties of blood access before dialysis, the intervention rate during dialysis, and venous pressure were lower in rt-PA
group than in urokinase group (5.1% vs. 10.7%, χ2=58.643, P=0.000 for difficulties of blood access before dialysis; 5.8% vs. 11.0%, χ2=48.027, P=0.000 for intervention rate during dialysis; 113.0±14.1 mmHg vs. 123.0±14.4 mmHg, q=3.154, P=0.037 for venous pressure) and control group (5.1% vs. 13.7%, χ2= 115.387, P=0.000 for difficulties of blood access before dialysis; 5.8% vs. 17.8%, χ2=187.411, P=0.000 for intervention rate during dialysis; 113.0±14.1 mmHg vs. 135.2±15.1 mmHg, q=6.854, P=0.005 for venous pressure). These parameters were also lower in urokinase group than in control group (P＜0.05). Blood flow volume was higher in rt-PA group than in urokinase group (248.1±14.9 ml/min vs. 239.1±14.2 ml/min, q=2.906, P=0.042) and control group (248.1±14.9 ml/min vs. 227.9±13.4 ml/min, q=6.378, P=0.006), and was higher in urokinase group than in control group (q=3.508, P＜0.05). The rates of bleeding and infection were similar among the 3 groups (χ2=0.233, P=0.890 for bleeding; χ2=1.541, P=0.463 for infection). Conclusion In addition to heparin, regular
use of rt-PA for blocking TCC can safely and effectively prevent thrombokinesis in TCC and increase dialysis blood volume.