老年患者中半永久血液透析导管临床应用分析

Using cuffed tunneled catheters as permanent vascular access for hemodialysis ingeriatric

目的总结老年患者半永久透析导管在透析患者中的有效性和并发症。方法回顾性分析2009年-2011年41例采用半永久透析导管作为透析通路的患者资料。共置放48枚导管，其中34例患者放置1枚导管，7例患者放置2枚导管，全部进行随访。结果41例患者均取得技术成功，透析流量达250ml／min以上。7枚导管因患者死亡而失用。3例因涤纶套外露而更换新管，6枚血栓性阻塞导管中3例未能开通而更换新管，1例因导管出口皮肤感染而换管，全部采用原位换管法。导管的中位通畅时间是260d（范围20-620d）。14例患者导管使用超过12个月，11例患者导管使用超过6个月。导管相关感染发生率0．9／1000个导管日。结论半永久透析导管是一种有效的透析通路，特别在没有其它永久通路的老年患者中更为重要。

Objective To evaluate survival and complications of semi-permanent tunneled cuffed catheters used for long-term hemodialysis in the geriatric. Methods A retrospective analysis was performed on 41 cases of which cuffed tunneled catheters as permanent vascular access were used in between 2009 and 2011. In the 41 cases, there were a total of 48 catheters inserted of which a single catheter was inserted in 34 patients and two catheters were inserted in the other 7 patients. A follow-up visit was performed on all the patients. Results The catheter was successfully inserted for all the 41 patients with dialysis volume of 250ml/min. Catheter removal took place on 7 cases due to the patient＇ s death, and 3 for thrombosis, and 1 for catheter-related infections. The median duration of catheter survival was 260 days, ranging from 20 to 620 days. In addition, there were 14 patients whose catheter（s） functioned well for over 12 months, and 11 patients whose catheter（s） functioned well for over 6 months. The total incidence of catheter related infections was 0.9 episodes/1000 catheter days. Conclusion The analysis indicates that semi-permanent tunneled cuffed catheters is a useful alternative permanent vascular access for hemodialysis geriatric patients while other forms of vascular access are not available.