68例Palindrome导管的临床应用观察

Clinic application and observation of 68 palindrome catheters as chronic dialysis access

目的探讨palindrome导管在长期深静脉导管留置术中的应用效果。方法登记自2009年5月至2011年5月在第二军医大学附属长征医院肾内科接受长期深静脉导管留置术的患者,选取其中采用palindrome导管与相同手术时间的非palindrome导管病例在进行比较。2组感染及低流量发生率用次/1000导管日表示,比较用χ2检验,平均带管时间比较用t检验。结果总手术234例次(229人),Palindrome导管组68例次,带管时间(381.08±44.61)d,发生感染2例次,平均感染率为0.08次/1000导管日,发生低流量23例次,平均发生率为0.5/1000导管日,拔管6例;普通导管组166例次,带管时间(273.11±25.41)d,感染19例次,平均感染率0.42次/1000导管日,发生低流量213例次,平均发生率为4.7次/1000导管日,拔管21例。2组在感染、低流量发生率及平均带管时间上存在统计学差异,Palindrome组优于普通导管组。6例Palindrome导管再循环为0,反接时未发生流量不佳。结论 Palindrome导管是临床深静脉长期留置导管术很好的选择,值得对其进行更大样本及更长时间的进一步临床观察。

Objective To explore the clinic outcome and advantages of palindrome catheter as the chronic dialysis access.Methods We registered the patients treated with long-term indwelling catheterization in deep vein for hemodialysis（HD）blood access from May 1,2009 to May 1,2011 in our center.Dwelling time and complications were observed and compared between patients with palindrome catheter group and those with non-palindrome catheter group.Result Long-term indwelling catheter was implanted to 229（234 times）patients with chronic renal failure.In palindrome catheter group（n=68）,dwelling time was 381.08±44.61 days,and infection occurred 2 times（0.08 times/1000 catheter-days）.Low blood flow occurred 23 times（0.5 times/1000 catheter-days）,and 6 catheters were finally removed.In non-palindrome catheter group（n=166）,dwelling time was 272.11±25.41 days,and infection occurred 19 times（0.42 times/1000 catheter-days）.Low blood flow occurred 213 times（4.7 times/1000 catheter-days）,and 21 catheters were finally removed.There are statistical differences between the two groups.In 6 cases in the palindrome catheter group,recirculation rate was zero and no low flow occurred on inverse connection.Conclusion Palindrome dialysis catheter is a better device for chronic HD patients because of longer dwelling time,lasting patency and lower infection rate.