【摘要】 目的回顾性分析血液透析患者带隧道带涤纶套导管(tunneled cuffed catheter,TCC)功能不良的影响因素。方法选取2016年1月至2018年6月在武汉市中西医结合医院行TCC置入术患者70例,置管位置均在右颈内静脉,每周透析3次,根据置管后3个月及12个月内是否发生导管功能不良(透析血流量低于200 mL/min,需要调整患者体位或反接透析管路、甚至溶栓治疗等干预措施)分为通畅组和非通畅组。记录患者的年龄、性别、原发病、身体质量指数、导管尖端位置,以及血红蛋白、血小板、白蛋白、血清总胆固醇(total cholesterol,TC)、三酰甘油、纤维蛋白原等临床资料。通过寻找通畅组与非通畅组之间变量的差异,计算3个月及12个月内的初级通畅率,分析TCC导管功能不良的影响因素。结果置管后3个月及12个月的导管初级通畅率分别为77.1%和62.9%。3个月时,导管尖端位于右心房的初级通畅率(91.2%)明显高于导管尖端位于上腔静脉(42.8%)及腔房交界处(68.9%)(P<0.05),12个月时,导管尖端位于右心房的初级通畅率有所下降(79.4%),仍明显高于导管尖端位于上腔静脉(42.8%)及腔房交界处(48.3%)(P<0.05)。在置管后3个月及12个月的通畅组及非通畅组之间,TC及导管尖端位置分布差异有统计学意义(P<0.05)。Logistic回归分析显示置管后3个月及12个月导管尖端位置及TC均对导管功能不良有独立预测意义(P<0.05)。结论 TCC导管3个月及12个月内导管功能不良的主要影响因素为较高的TC水平及不良的导管尖端位置。更多还原

【Abstract】 Objective To retrospectively analyze the influencing factors of tunneled cuffed catheter(TCC) dysfunction in hemodialysis patients.Methods A total of 70 patients,who underwent TCC implantation in Wuhan Hospital of Traditional Chinese and Western Medicine from January 2016 to June 2018 were selected.Their implantation sites were in right internal jugular vein.They received dialysis 3 times every week.According to whether there was catheter dysfunction within 3 months and 12 months,after implantation(if dialysis blood flow was below 200 mL/min,some intervention measures including body position adjustment,inversion of tube connection and thrombolysis),the patients were divided into patent group and blocked group.Their ages,sex,protopathy,body mass index(BMI),location of catheter tip,hemoglobin(Hb),platelet(PLT),albumin(Alb),total cholesterol(TC),triglyceride(TG),fibrinogen(Fib) were collected.By means of comparing variables between patent groups and blocked groups,the primary patency rate of the catheters was calculated,and the influencing factors of catheter dysfunction were identified. Results The primary patency rate of the catheters were 77.1% and 62.9% in 3 and 12 months after implantation.At 3 months after implantation,the primary patency rate with catheter tips in the right atrium(91.2%) were much higher than those with catheter tips in the superior vena cava(42.8%) and pericavoatrial junction(68.9%)(P<0.05).At 12 months,the primary patency rate with catheter tips in the right atrium decreased(79.4%),but was still much higher than those with catheter tips in the superior vena cava(42.8%) and pericavoatrial junction(48.3%)(P<0.05).At 3 and 12 months after implantation,TC and catheter tip position had statistical differences between the patent group and the blocked group(P<0.05).Logistic regression analysis showed that TC and location of catheter tip had independent predictive value for catheter dysfunction at both 3 and 12 months after implantation(P<0.05).Conclusions The main influencing factors of tunneled cuffed catheter dysfunction within 3 and 12 months are higher total cholesterol and abnormal catheter tip position.更多还原