股静脉隧道式带cuff双腔导管不同的尖端位置对血液透析血流量的影响

The influence of different tip position of femoral vein tunnel double lumen catheter with cuff on hemodialysis blood flow

目的探讨股静脉隧道式带cuff双腔导管不同的尖端位置对血液透析血流量的影响。方法选取2017年1月~2019年4月我院收治的股静脉隧道式带cuff双腔导管维持性血液透析患者45例。通过置管术后X线检查观察导管尖端位置对应椎体的位置进行分组,以胸12~腰1组为A组(n=13)、腰2~腰3为B组(n=17)、腰4~腰5为C组(n=15),记录首次使用股静脉留置导管血液透析1 h时动脉端实际最大血泵流量(mL/min),比较各组之间的血流量及尿素清除分数(Kt/V);对患者进行为期6个月的观察,记录导管使用情况,分为导管功能良好,因感染、堵塞所致拔管,因导管功能不良停用的发生情况。结果B组血流量、Kt/V明显高于A组和C组,差异均有统计学意义(P<0.05);A组血流量、Kt/V与C组比较,差异无统计学意义(P>0.05);截止至随访6个月,三组患者导管功能良好,感染、堵塞所致拔管,导管功能不良停用的发生率比较,差异均无统计学意义(P>0.05)。结论股静脉隧道式带cuff双腔导管尖端位置在腰2~腰3位置时血液透析血流量最佳,该位置可能为最近留置位置。

Objective To explore the influence of different tip position of femoral vein tunnel double lumen catheter with cuff on hemodialysis blood flow.Methods 45 patients with dual lumen catheter maintenance hemodialysis in our hospital from January 2017 to April 2019 were selected as study subjects.After catheterization,X-ray examination was used to observe the position of the tip of the catheter corresponding to the vertebral body.Chest 12-waist 1 were the group A(n=13),waist 2-waist 3 were group B(n=17)and waist 4-waist 5 were group C(n=15).The actual maximum blood pump flow(mL/min)at the arterial end was recorded when the catheter was first used for hemodialysis.The blood flow and urea clearance fraction(Kt/V)were compared between groups.The patients were observed for 6 months to record the use of catheters,which were divided into good function,extubation due to infection and blockage,and discontinuation due to poor function of catheters.Results The blood flow and Kt/V of group B were significantly higher than those of group A and group C(P<0.05),while there was no significant difference between group A and group C(P>0.05);After 6 months of follow-up,there was no significant difference between the three groups in the incidence of good function,catheter removal triggered by infection and blockage,and discontinuation due to poor function of catheters(P>0.05).Conclusion When the tip of femoral vein tunnel double lumen catheter with cuff is at the position of waist 2-waist 3,the hemodialysis blood flow is the best and this position can be the nearest one for preservation.