经股静脉置入隧道式带涤纶套双腔导管尖端位置和流量的关系

Relationship between position of the tip and flow rate of the tunneled cuffed catheter in femoral vein

目的 研究经股静脉置入隧道式带涤纶套双腔导管尖端位置和流量的关系。方法 选取经股静脉置入隧道式带涤纶套双腔导管(Tunneled Cuffed Catheter,TCC)维持性血液透析患者215例。根据X线检查观察导管远端尖端对应椎体的位置进行分组,以第3腰椎(third lumbar vertebrae,L3)为中心分为A组(导管远端尖端在第3腰椎下缘以下),B组(导管远端尖端在第3腰椎位置),C组(导管远端尖端在第3腰椎上缘以上)。记录首次使用TCC血液透析1h内导管动静脉端实际泵流量(ml/min),比较各组间流量。结果 克鲁斯卡尔-沃利斯K-W检验,χ~2=11.5,Df=2,P=0.003(P<0.05)。3组间血流量是不同的,A组平均血流量235.3±25.5ml/min,B组平均血流量249.5±18.1ml/min,C组平均血流量234.7±26.8ml/min。组间两两比较采用曼-惠特尼U检验,P(A组/B组)0.013,P(B组/C组)0.001,P(C组/A组)0.722,其中P(B组)<0.05,差异有统计学意义。结论 经股静脉置入TCC流量与导管远端尖端位置有关,导管尖端在腰椎L3位置血流量最佳。腰椎L3水平可能是导管尖端在下腔静脉的最佳位置。各组导管尖端位置流量不同可能与下腔静脉解剖结构有关。

Objective To study the relationship between tip position and flow rate of the tunneled cuffed catheter （TCC） in femoral vein.Methodology We selected 215 cases of maintenance hemodialysis patients with TCC in femoral vein.According to X-ray examination,distal tip of the catheter was categorized into group A,group B and group C.Blood flow （ml/min） was recorded within one hour of the first hemodialysis.Blood flow was compared between the groups.Results of Kruskal-Wallis test showed that χ^2=11.5,Df=2 and P=0.003.Average blood flow was different between the 3 groups,with 235.3±25.5ml/min in group A,249.5± 18.1ml/min in group B and 234.7±26.8ml/min in group C.Comparison between the groups using Mann-Whitney U test showed that the difference was statistically significant in group B （P〈0.05）.Conclusion Blood flow of the tunneled cuffed catheter in femoral vein was related to the position of the catheter tip.At L3 level,the blood flow was the highest.The most suitable tip position was at L3 level in inferior vena cava.The different flow rate within a group may relate to the anatomical variation of inferior vena cava.