带涤纶套中心静脉长期导管在血液透析患者中的生存状况及影响因素分析

Survival rate of long-term cuffed central venous catheter on maintenance hemodialysis and analysis of its related dangerous factors

目的观察分析带涤纶套中心静脉长期导管在维持性血液透析(MHD)患者中的生存率,探讨影响导管生存的危险因素。方法 59例血透患者行右侧颈内静脉留置带涤纶套长期导管,将导管失功作为终点事件来确定导管生存时间,计算导管生存率;用Kaplan-Meier法观察中位导管生存时间和比较导管近远期生存率,Cox回归模型分析影响长期导管寿命的相关因素。结果 59例患者发生导管失功14例,失功率23.73%,中位导管生存时间37个月,近期(12个月)和远期(36个月)导管生存率分别为80.90%和58.70%;糖尿病肾病(DN)组近期和远期导管生存率接近非DN组(85.30%、45.80%vs 90.00%、41.50%)P>0.05,Cox回归分析:既往同侧静脉置管次数增加,导管动脉外接头位置靠外,低白蛋白血症,低胆固醇血症,和导管相关感染(CRI)的次数增多是影响导管寿命的主要危险因素。结论长期导管的近期和远期生存率理想,是MHD、尤其是DN患者较为理想的血管通路;既往置管次数增加、导管动脉外接头靠外、低白蛋白血症、低胆固醇血症、高CRI可以影响导管寿命。

[ Objective ] To investigate the survival rate of long-term cuffed central venous catheter on maintenance hemodialysis and analysis its related risk factors. [ Methods ] The cuffed catheter was indwelled in right internal jugular vein in 59 cases. The survival time and survival rate of catheter were calculated based on the endpoint event-catheter dysfunction. Clinic data of cases were collected. The Kaplan-Meier method of measuring catheter survival rate was applied. The risk factors were analyzed by Cox regression analysis. [Results] 14 of the 59 cases had catheter dysfunction. The dysfunction rate was 23.73%. Median catheter survival time were 37 months. 12-month catheter survival rate was 80.90%, 36-month catheter survival rate was 58.70%. Immediate and long-term catheter survival rates in diabetic nephropathy （DN） group were closed to them in non-DN group （P 〉0.05）. The Cox regression model showed that increasing venipunctures, the position of catheter＇s external artery connector, low levels of serum albumin and cholesterol, and increasing catheter-related infections （CRI） correlated with catheter survival. [ Conclusion] A cuffed central venous catheter has an acceptable immediate and long-term survival rate and is an ideal vascular access to hemodialysis patients, including patients of DN. Increasing venipunctures, the outer position of eatheter＇s external artery connector, low levels of serum albumin and cholesterol, and increasing CRI are risk factors of catheter survival.