腹膜透析管植入术后休整期与腹透导管相关并发症间关系的临床研究

Clinical Analysis on the Relations between Break-in Period After Peritoneal Dialysis Catheter Insertion and the Catheter Related Complications

目的:分析腹膜透析管植入术后至开始腹膜透析时的时间间隔(手术后休整期)与患者腹透导管相关并发症之间的关系,寻找合适的腹膜透析导管术后休整期。方法:回顾性总结本科室从1997年以来部分实行腹膜透析管植入术并长期随访的腹膜透析患者154例,根据腹透管置管植入术后休整期长短不同分为3组,7 d以内组(时间<7 d)、7 d以上组(7 d≤时间<14 d)和14 d以上组(时间≥14 d),分析3组患者的原发疾病,术前白蛋白和肌酐水平、腹透液渗漏、腹透管移位、大网膜包裹等腹透导管相关并发症的发生情况,以及手术干预的例次。结果:各组中疾病谱分布、术前血清白蛋白及肌酐值水平差异无统计学意义(P>0.05);7 d以内组患者发生腹透液渗漏发生率(10.0%)、腹透管移位发生率(22.5%)、大网膜包裹发生率(20.0%)均高于其余两组(P<0.05);7 d以上组和14 d以上组之间上述并发症发生率相当(P>0.05);7 d以内组需手术处理的并发症(81.0%)显著高于其他两组(P<0.05)。结论:腹膜透析管植入术后7～14 d的休整期能明显减少腹透导管相关并发症的发生,是比较合适的休整期。

Objective：To study the relations between the catheter-related complications and break-in periods after peritoneal dialysis（PD） catheter insertions,and to find an ideal break-in period to start the peritoneal dialysis treatment suitable for domestic medical conditions.Methods：From 1997,154 patients treated with implantations of the peritoneal dialysis catheter in our department and with long-term follow-up data available were retrospectively studied.These patients were divided into three groups according to different break-in periods after PD catheter insertions：less than 7 days group（break-in period 7 days）,more than 7 days group（7 days≤ break-in period 14 days）,and more than 14 days group（break-in period≧14 days）.The underlying diseases,preoperative levels of the serum albumin and creatinine,rates of the dialysis fluid leakage,drifting of the dialysis catheter and encapsulated omentum were recorded,as well as the incidence of catheter re-implantations and non-operative treatments were compared in the three groups.Results：There was no statistical difference in the distribution of diseases among the three groups（P0.05）.No statistical difference in the preoperative levels of the serum albumin and creatinine was detected in the three groups（P0.05）.The rates of dialysis？fluid leakage,drifting of the dialysis catheter and encapsulated omentum in less than 7 days group was higher than that of the other two groups（P0.05）,and the incidences between the other two groups were comparative（P0.05）.The incidence of surgical treatment was significantly higher in the less than 7 days group（P0.05）.Conclusion：Catheter-related complications were obviously reduced in patients with break-in period between 7 to 14 days,suggesting a proper break-in period between 7 to 14 days in China.