带涤纶套中心静脉长期导管在MHD患者中的生存情况及其危险因素分析

Analysis on the Survival of Long-Term Central Venous Catheter with Polyester Sheath in MHD Patients and Its Risk Factors

目的探讨使用带涤纶套中心静脉长期导管的维持性血液透析(MHD)患者的导管生存情况和影响导管生存的相关危险因素。方法选择MHD患者40例,进行为期5年的随访,统计随访期间的导管失效事件。绘制Kaplan-Meier生存曲线,比较糖尿病肾病和非糖尿病肾病患者导管生存的差异。采用多因素Cox回归模型分析影响导管生存的危险因素。结果导管中位生存时间为52(9~70)个月,共发生导管失效事件24例,发生率为60.00%。糖尿病肾病与非糖尿病肾病患者的导管生存率无统计学差异[HR=0.649,95%CI(0.275,1.440),P=0.189]。Cox回归模型显示,血红蛋白水平、透析前CVP和导管相关感染是影响导管生存的独立危险因素。结论 MHD患者的带涤纶套中心静脉长期导管远期存在较高的失效率,血红蛋白水平、透析前CVP和导管相关感染是影响导管生存的独立危险因素。

Objective To observe the survival of long-term central venous catheter with polyester sheath in MHD patients and its risk factors. Methods 40 cases of MHD patients were enrolled and followed up for 5 years. The catheter-failure event during the follow-up period was recorded. Kaplan-Meier survival curve was drawn to compare the survival of catheter between diabetic nephropathy patients and non-diabetic nephropathy patients. Multivariate Cox regression model was used to analyze the associated risk factors for the survival of catheter. Results The median survival time of catheter was 52 （9 ~ 70） months, and 24 cases had catheter-failure events, with the incidence of 60.00%. There was no significant difference in catheter survival between diabetic nephropathy patients and non-diabetic nephropathy patients [（HR = 0.649, 95% C1 （0.275, 1.440）, P = 0.189]. Cox regression model showed that hemoglobin level, pre-dialysis CVP, and catheter-related infection were the independent risk factors for catheter survival. Conclusions Long-term central venous catheter with polyester sheath in MHD patient has a high failure rate in the long-term presence. Hemoglobin levels, pre-dialysis CVP and catheter-related infection are the independent risk factors for the survival of catheter.