腹膜透析导管两种不同拔除方法的临床观察

Comparison of clinical effects of two different methods of peritoneal dialysis catheter removal

目的比较腹膜透析导管两种不同拔除方法的有效性及安全性。方法回顾性研究2015年5月至2020年6月在连云港市第一人民医院和徐州市第三人民医院肾内科住院行腹膜透析导管拔除的51例患者的临床资料,分为常规拔管组24例和"pull"组27例。分析比较两组患者的基本资料、导管类型、导管使用时间、手术时间、住院时间及费用、手术器械、术后疼痛程度评分、术后止疼药物应用情况、术后护理、术后并发症情况。结果①"pull"组与常规拔管组相比,手术时间较短[(17.8±2.5)min vs.(68.3±11.9)min,t=-15.923,P<0.001]、住院时间较短[(6.4±0.9)d vs.(10.7±3.1)d,t=-6.608,P<0.001)、住院费用较少[(1950.8±529.8)元vs.(2974.2±1267.9)元,t=-3.679,P=0.001]、术后疼痛程度更轻[(4.00±0.78)分vs.(1.26±0.59)分,P<0.001];②"pull"组随访3~15个月,术中出现导管断裂3例,未出现其他并发症。结论与常规拔管术相比,"pull"方法是安全、实用和微创的。推荐对置管时间<5年者常规使用"pull"技术,≥5年者也可以视情况应用。

Objective To compare the effectiveness and safety of two different methods of peritoneal dialysis catheter removal.Methods Retrospective analysis was made on the data of 51 patients,who underwent peritoneal dialysis catheter removal admitting to the department of nephrology in Lianyungang first people's hospital and Xuzhou third people's hospital from May 2015 to June 2020.Twenty-four cases in the conventional extubation group and 27 cases in the"pull"group.The basic clinical data,catheter type,catheter use times,operation times,hospitalization times and costs,sur-gical instruments,postoperative painkillers,postoperative pain degree scores,postoperative nursing,postoperative bleeding and postoperative complications were analyzed,and compared between the two groups.Results①Compared with the conventional extubation group,the operation time of the"pull"group was was short(17.8±2.5)min vs.(68.3±11.9)min,t=-15.923,P<0.001),the hospitalization time was short(6.4±0.9)d vs.(10.7±3.1)d,t=-6.608,P<0.001),and the hospitalization cost was less(1950.8±529.8)yuan vs.(2974.2±1267.9)yuan,t=-3.679,P=0.001),postoperative pain was less severe[(4.00±0.78)points vs.(1.26±0.59)points,P<0.001].②In the"pull"group,3 cases of catheter fracture were followed up for 3-15 months.No other complications occurred.Conclusions Compared with conventional extubation,the'pull’technique is safe,practical,and minimally invasive.Recommending time for catheterization is less than 5 years.However,for those who have been using the pull technique for more than 5 years,they can also use it as appropriate.