血液透析长期中心静脉留置导管功能不良发生率及影响因素分析

Dysfunction of long-term indwelling central venous catheterization for hemodialysis: Its incidence and analysis of related factors

目的探讨血液透析中带涤纶套中心静脉留置导管的初级通畅率(从置管到第1次干预)及其影响因素。方法实施中心静脉长期留置带涤纶套导管30例,均为右侧颈内静脉置管,根据置管后3个月内是否出现导管功能不良(连续3次血流量低于200ml/min,需要调整体位、反接透析管路,甚至溶栓治疗等干预措施),计算出3月内初级通畅率;并将其分成通畅组和非通畅组;记录置管时患者的年龄、性别、血压,以及血红蛋白(hemoglobin,Hb)、红细胞压积(hematocrit,Hct)、凝血酶原时间(prothrombin time,PT)、活化部分凝血活酶时间(activated partial thromboplastin time,APTT)、血小板(platelet,Plt)、血清总胆固醇(total cholesterol,TC)、三酰甘油(triglyceride,TG)、低密度脂蛋白胆固醇(lowdensity li-poprotein cholesterol,LDL-C)、白蛋白(albumin,Alb)等指标;达到干体重并行规律透析后分别记录3次透析时血流量、超滤量、管路静脉压、透析前后中心静脉压(central venous pressure,CVP),取其平均值;通畅组与非通畅组间连续变量的差异比较使用t检验,分类变量的差异比较使用χ2检验,比较两组之间的差别,并从中找出影响导管初级通畅率的相关因素。结果入选患者30例,3个月内出现导管功能不良7例,出现时间从17d至89d;其余23例3个月内均血流通畅,导管3个月内的初级通畅率为76.7%;30例患者中通畅组与非通畅组的年龄、男女比、糖尿病所占比例差异均无统计学意义(t=0.758,χ2=0.142,χ2=0.419,均P>0.05);通畅组比非通畅组具有较低的Hb和Hct,具有较高的APTT和透析前CVP,差异均有统计学意义(均P<0.05);两组之间血压、平均超滤量、透析中血流量、平均管路静脉压、透析后平均CVP以及PT、Plt、TC、TG、LDL-C、Alb比较差异无统计学意义(P>0.05)。结论带涤纶套中心静脉留置导管3个月内的功能不良的主要影响因素为过高的Hb、Hct,过低的APTT,以及过低的透析前CVP。

Objectives To investigate the primary patency rate （from catheter setting to the first intervention） of long-term cuffed central venous catheter for hemodialysis and its related factors. Methods The cuffed central venous catheter was indwelled in right internal jugular vein in 30 cases. The primary patency rate of the catheters was calculated based on the catheter dysfunction rate, i.e., blood flow （BF） 〈200 ml/min for three times and requirement of intervention measures including body position adjustment, inversion of tube connection during hemodialysis, and thrombolysis therapy in the first 3 months. The patients were then assigned into patent group and blocked groups. Their ages, gender, blood pressure, Hb, hematocrit （Hct）, prothrombin time （PT）, activated partial thromboplastin time （APTT）, platelet （Pit）, total cholesterol （TC）, triglyceride （TG）, low density lipoprotein cholesterol （LDL-C）, albumin （Alb） were collected. The average BF, ultrafiltration volume （UF） and venous pressure in tube during hemodialysis from 3 observations, as well as central venous pressure （CVP） before and after hemodialysis from 3 observations were recorded when the patients reached to dry body weight and the hemodialysis was running on a steady status. Ttest was used for the comparison of continuous variables, and Chi square test was performed for the comparison of classified variables between the two groups. Results （A） In the first 3 months of catheterization, 7 of the 30 cases were found to have catheter dysfunction beginning from the 17-89^th days after the operation. The patency rate was 76.7% in the first 3 months. （B） There were no differences in age, gender and diabetes between the 2 groups. （C） Lower Hb and Hct, and higher APTT and pre-hemodialysis CVP were found in patent group, as compared with those of blocked group. There were no differences in blood pressure, PT, Pit, TC, TG, LDL-C, Alb, BF, UF, venous pressure in tube, and post-hemodialysis CVP between the two groups. Conclu- sions The major factors relating to dysfunction of cuffed long-term indwelling central venous catheter are higher Hot and Hb, and lower APTT and pre-hemodialysis CVP.