股静脉隧道式带涤纶套导管作为血液透析过渡通路的临床效果观察

Clinical Efficacy of a Femoral Vein Tunneled Cuffed Catheter as a Transitional Pathway for Hemodialysis

目的探讨股静脉隧道式带涤纶套导管(股静脉半永久导管)作为血液透析过渡通路的临床应用效果。方法 2015年1月—2017年1月在厦门大学附属第一医院共完成血液透析过渡通路138例,其中股静脉半永久导管(股静脉组)36例,颈内静脉半永久导管(颈内静脉组)40例,各种中心静脉临时导管(股静脉、颈内静脉临时导管,临时导管组)62例,3组患者的自体动静脉内瘘手术均在置管1周内完成,记录3组插管时并发症(手术出血情况)、插管次数、导管留置时间、透析充分性、透析血流量、导管使用情况。结果 3组患者手术出血率比较,差异无统计学意义(P>0.05);3组患者插管次数、导管留置时间、尿素清除分数(Kt/V)、透析血流量、导管使用情况比较,差异均有统计学意义(P<0.05);其中股静脉组和颈内静脉组插管次数少于临时导管组,导管留置时间长于临时导管组,Kt/V高于临时导管组,透析血流量多于临时导管组,导管功能良好率高于临时导管组(P<0.05或P<0.01)。结论股静脉半永久导管作为血液透析过渡通路优于各种临时导管,与颈内静脉半永久导管作为血液透析过渡通路的作用类似。

Objective To assess the clinical efficacy of a femoral vein tunneled cuffed catheter(femoral vein semipermanent catheter),as a transitional pathway for hemodialysis.Methods A total of 138 patients who underwent construction of a transitional pathway for hemodialysis in the First Affiliated Hospital of Xiamen University from January 2015 to January 2017 were enrolled,which included 36 cases with the use of femoral vein semi-permanent catheters(femoral vein group),40 with the use of internal jugular vein semi-permanent catheters(internal jugular group),and 62 with the use of various temporary central venous catheters(temporary catheter group).Autologous arteriovenous fistula surgery was performed within 1 week after catheterization in all three groups,and the incidence of immediate complications of catheterization(bleeding),time of catheterization,duration of catheter indwelling,dialysis adequacy,blood flow in dialysis,and the status of using catheters were recorded and compared among the three groups.Results There was no significant differences in percentage of intraoperative bleeding among the three groups(P>0.05),while significant differences were detected in the frequency of catheterization,duration of catheter indwelling,the fraction of renal urea clearance relative to distribution volume(Kt/V),blood flow in dialysis,and status of catheter use(P<0.05).The frequency of catheterization was lower in the femoral vein group and internal jugular group than in the temporary catheter group,while the duration of catheter indwelling,Kt/V,blood flow in dialysis,and rate of catheters with good function were greater in the femoral vein group and internal jugular group than in the temporary catheter group(P<0.05 or 0.01).Conclusion As a transitional pathway for hemodialysis,femoral vein semi-permanent catheters are superior to a variety of temporary catheters,which are similar to jugular vein semi-permanent catheters as a transition pathway for hemodialysis.