血液透析长期中心静脉导管留置功能不良的影响因素分析

Factors influencing dysfunction of long-term indwelling central venous catheters for hemodialysis

目的探讨长期中心静脉导管功能不良的影响因素。方法以长期中心静脉导管为血管通路的维持性血液透析患者158例为研究对象,根据是否发生导管功能不良分为功能良好组112例和功能不良组46例。比较两组血红蛋白(Hb)、血细胞比容(Hct)、白蛋白(Alb)、血小板(Plt)、血清总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、超敏C反应蛋白(hsCRP)、凝血酶原时间(PT)、部分活化的凝血酶时间(APTT)、血流量(BF)、纤维蛋白原(FIB)、超滤量(UF)、尿素清除指数(Kt/v)、导管留置时间、导管相关感染、封管方法、是否患有糖尿病、口服抗凝药物情况。利用logistic回归分析导管功能不良的影响因素。结果功能良好组较功能不良组Alb(38.7±5.6)g/L vs(36.6±5.4)g/L和BF(256.41±25.8)ml/min vs(218.26±26.6)ml/min较高,hsCRP(3.24±2.11)mg/L vs(6.38±4.18)mg/L较低(P<0.05或<0.01),导管相关感染发生率较低,23.2%(26/112)vs 45.7%(21/46);尿激酶封管率较高31.3%(35/112)vs 13.0%(6/46)(P<0.05或<0.01);Logistic回归结果显示:较高的hsCRP,导管相关感染是导管功能不良发生的危险因素。而较高的血清Alb和每周1次尿激酶替代肝素封管是降低导管功能不良的影响因素。结论提高患者的Alb水平,控制导管相关感染的发生,降低hsCRP水平,每周1次尿激酶代替肝素封管有利于降低中心静脉导管功能不良的发生。

Objective To explore the factors influencing the dysfunction of long-term indwelling central venous catheters for hemodialysis. Methods We analyzed 158 maintenance hemodialysis patients who used long-term indwelling cuffed catheter. Patients were assigned into function and dysfunction group according to the function of their catheters,function group 112 and dysfunction group 46. Their hemoglobin （ Hb）, hematoerit （Hct）, serum albumin （ Alb）, plateiet （ PLT）, total cholesterol （ TC）, triglyceride （ TG）, low density lipoprotein cholesterol （ LDL-C）, high sensitivity C-reactive protein（ hsCRP）, prothrombin time （ PT）, activated partial thromboplastin time （ APTT）, blood flow（BF）, fibrinogen（FIB）, Ultrafiltration volume（UF）, Kt/v, time of catheter dialysis, catheter related infections, catheter locking methods,diabetes or not, and oral anticoagulants drug therapy were measured or recorded to compare the differences between two groups. Independent predictors of catheter dysfunction were determined by multivariate logistic regression. Results The function group had higher Alb, blood flow and lower hsCRP in comparison with the dysfunction group,Alb（38. 7±5. 6） g/L vs （36.6±_5.4）g/L,BF（256.41±25.8） ml/min vs （218.26±26.6） ml/min, hsCRP（3.24±2.11） mg/L vs （6.38±4.18） mg/L（ P 〈0.05 or〈0.01）. The function group had lower rate of catheter related infection than the dysfunction group, 23.2% （ 26/112 ） vs 45.7% （ 21/46 ） ; higher percentages of urokinase instead of heparin locking solution,31.3%（35/112）vs 13.0%（6/46）（ P 〈0.05 or 〈0.01）. By multivariate logistic regression, higher hsCRP and catheter related infection were the risking factors of catheter dysfunction, higher Alb and rokinase instead of heparin once weekly as a locking solution were the influencing factors of lower catheter dysfunction. Conclusion Enhancing AIB, controlling catheter related infection, redueing hsCRP, rokinase instead of heparin once weekly as a locking solution may lower the dysfunction rate of central venous catheters.