超声对血液透析患者中心静脉置管早期流量不足的影响因素分析

The value of ultrasound in assessment of the factors influencing on the early insufficient flow of central venous catheter in dialysis patients

目的应用超声评估血液透析患者中心静脉导管置入后早期流量不足的影响因素。方法收集2016年5月至2019年6月在承德医学院附属医院行中心静脉导管置入术的血液透析患者327例,并将其分为导管低流量组(43例)和导管正常流量组(284例)。比较两组患者临床一般资料(年龄、性别、血压),并分析经胸超声心动图相关测量参数(导管尖端位置、左室射血分数、左房收缩末期内径、左室舒张末期内径、导管尖端距上腔静脉入右心房口距离)是否对患者早期导管流量不足产生影响。结果两组患者左房收缩末期内径、左室射血分数以及导管位置差异有统计学意义(均P<0.05)。单因素与多因素分析显示,导管尖端接近和触及右心房壁(OR=5.393,95%CI=2.039~14.263,P=0.001)、左房收缩末期内径增大(OR=0.321,95%CI=0.124~0.827,P=0.019)、左室射血分数处于临界范围(OR=2.953,95%CI=1.113~7.835,P=0.030)和减低(OR=5.828,95%CI=1.869~18.174,P=0.002)是术后早期导管流量不足的独立危险因素。结论中心静脉置管术后早期导管流量不足与导管位置、左房收缩末期内径、左室射血分数相关,超声可以作为评估透析患者术后导管尖端位置和诊断术后早期流量不足的主要方法。

Objective To evaluate the value of ultrasonography in evaluating the influential factors of early insufficient flow after central venous catheter placement in dialysis patients.Methods Three hundred and twenty seven hemodialysis patients who underwent central venous catheterization at the Affiliated Hospital of Chengde Medical College from May 2016 to June 2019 were selected.According to the catheter flow,the patients were divided into the low catheter flow group(43 cases)and the normal catheter flow group(284 cases).The distribution variance of clinical features(age,gender,blood pressure)were compared and whether some ultrasonic parameters(position of catheter tip,left ventricular ejection fraction,left atrial end-systolic diameter,left ventricular end-diastolic diameter,distance from the catheter tip to superior vena cava beyond right atrial opening)had influence on the insufficient catheter flow in the early stage between the two groups were analyzed.Results The differences of left ventricular ejection fraction,left atrial end-systolic diameter and position of catheter tip between the two groups were statistically different(P<0.05).However,univariate and multivariate analyses showed that there were significant differences in catheter tip approaches and touches the wall of right atrium(OR=5.393,95%CI=2.039-14.263,P=0.001),increased left atrial end-systolic diameter(OR=0.321,95%CI=0.124-0.827,P=0.019),left ventricular ejection fraction in critical range(OR=2.953,95%CI=1.113-7.835,P=0.030)and decreased left ventricular ejection fraction(OR=5.828,95%CI=1.869-18.174,P=0.002)were the independent risk factors of early insufficient catheter flow.Conclusions Insufficient catheter flow after central venous catheterization is related to catheter position,left atrial end-systolic diameter and left ventricular ejection fraction.Ultrasonography evaluation is a primary method to observe the position of the catheter tip in dialysis patients and diagnose the early insufficient catheter flow after central venous catheterization.