中华老年医学杂志
中華老年醫學雜誌
중화노년의학잡지
Chinese Journal of Geriatrics
2012年
9期
782-785
,共4页
肾透析%导管插入术%导管,留置
腎透析%導管插入術%導管,留置
신투석%도관삽입술%도관,류치
Renal dialysis%Catheterization%Catheters,indwelling
目的 比较应用带涤纶环半永久导管透析的老年患者首次、再次置管后,导管总使用时间及无感染使用时间. 方法 选择老年患者57例,其中男性32例,女性25例,年龄61～86岁,平均(72.4±6.7)岁.共行导管131例次(首次57例、再次74例)；再次导管中导丝引导下在原血管中放置导管(wire guided exchange,WGE)48例次,拔除导管后在其他部位重新置人导管(removal and replacement,RAR)26例次,共2686导管月.因导管相关性菌血症换管占42.0％(55/131),因失功或涤纶环滑出隧道换管占28.2％(37/131),选择性拔管或仍在使用导管占29.9％(39/131). 结果 首次置管组和再次置管组1年导管无感染使用率分别为35.8％和28.4％,首次置管组的导管使用时间长于再次置管组,分别为(29.8±7.9)个月对(28.7±6.0)个月(t=0.711,P=0.443).首次置管组的无感染使用时间与再次置管组比较[(13.1±3.5)个月对(11.6±2.7)个月],差异有统计学意义(t=2.415,P=0.018).WGE组与RAR组比较,总导管使用时间[(28.2±7.2)个月对(28.5±5.8)个月,t=-0.163]和无感染使用时间[(11.1±3.1)个月对(12.2±2.1)个月,t=0.103],差异均无统计学意义(均P＞0.05).与首次置管组及WGE组比较,原位治疗后无感染使用时间[(8.20±2.14)个月]明显缩短,差异有统计学意义(t=7.602,5.601,P＜0.05). 结论 无隧道及创口感染的患者进行WGE安全、有效,同时有保存血管通路放置部位的获益.
目的 比較應用帶滌綸環半永久導管透析的老年患者首次、再次置管後,導管總使用時間及無感染使用時間. 方法 選擇老年患者57例,其中男性32例,女性25例,年齡61～86歲,平均(72.4±6.7)歲.共行導管131例次(首次57例、再次74例)；再次導管中導絲引導下在原血管中放置導管(wire guided exchange,WGE)48例次,拔除導管後在其他部位重新置人導管(removal and replacement,RAR)26例次,共2686導管月.因導管相關性菌血癥換管佔42.0％(55/131),因失功或滌綸環滑齣隧道換管佔28.2％(37/131),選擇性拔管或仍在使用導管佔29.9％(39/131). 結果 首次置管組和再次置管組1年導管無感染使用率分彆為35.8％和28.4％,首次置管組的導管使用時間長于再次置管組,分彆為(29.8±7.9)箇月對(28.7±6.0)箇月(t=0.711,P=0.443).首次置管組的無感染使用時間與再次置管組比較[(13.1±3.5)箇月對(11.6±2.7)箇月],差異有統計學意義(t=2.415,P=0.018).WGE組與RAR組比較,總導管使用時間[(28.2±7.2)箇月對(28.5±5.8)箇月,t=-0.163]和無感染使用時間[(11.1±3.1)箇月對(12.2±2.1)箇月,t=0.103],差異均無統計學意義(均P＞0.05).與首次置管組及WGE組比較,原位治療後無感染使用時間[(8.20±2.14)箇月]明顯縮短,差異有統計學意義(t=7.602,5.601,P＜0.05). 結論 無隧道及創口感染的患者進行WGE安全、有效,同時有保存血管通路放置部位的穫益.
목적 비교응용대조륜배반영구도관투석적노년환자수차、재차치관후,도관총사용시간급무감염사용시간. 방법 선택노년환자57례,기중남성32례,녀성25례,년령61～86세,평균(72.4±6.7)세.공행도관131례차(수차57례、재차74례)；재차도관중도사인도하재원혈관중방치도관(wire guided exchange,WGE)48례차,발제도관후재기타부위중신치인도관(removal and replacement,RAR)26례차,공2686도관월.인도관상관성균혈증환관점42.0％(55/131),인실공혹조륜배활출수도환관점28.2％(37/131),선택성발관혹잉재사용도관점29.9％(39/131). 결과 수차치관조화재차치관조1년도관무감염사용솔분별위35.8％화28.4％,수차치관조적도관사용시간장우재차치관조,분별위(29.8±7.9)개월대(28.7±6.0)개월(t=0.711,P=0.443).수차치관조적무감염사용시간여재차치관조비교[(13.1±3.5)개월대(11.6±2.7)개월],차이유통계학의의(t=2.415,P=0.018).WGE조여RAR조비교,총도관사용시간[(28.2±7.2)개월대(28.5±5.8)개월,t=-0.163]화무감염사용시간[(11.1±3.1)개월대(12.2±2.1)개월,t=0.103],차이균무통계학의의(균P＞0.05).여수차치관조급WGE조비교,원위치료후무감염사용시간[(8.20±2.14)개월]명현축단,차이유통계학의의(t=7.602,5.601,P＜0.05). 결론 무수도급창구감염적환자진행WGE안전、유효,동시유보존혈관통로방치부위적획익.
Objective To compare the infection free and overall survival between first and subsequent tunneled cuffed hemodialysis catheters in geriatric patients.Methods The study involved57 geriatric patients [32 male,25 female; mean age (72.4 ± 6.7) years]undergoing maintenance hemodialysis in our blood purfication unit over a period of 72 months.Among a total of 131 catheters and 2686 catheter months including 57 first catheters and 74 consecutive catheters,48 wire guided exchange (WGE) and 26 removal and replacement (RAR),55/131 (42.0％) catheters were exchanged because of catheter-related bacteremia (CRB),37131 (28.2％) exchanged because of malfunction or cuff extrusion,39 /131 (29.9％)catheters were removed electively or was still functional at the end of the study period.Results One-year survival rates for first and consecutive catheters were 35.8％ and 28.4％,respectively.There was no difference in the overall survival between first catheters group and subsequent catheters group [(29.8±7.9)months vs.(28.7±6.0)months,t=0.711,P=0.443].However,infection free survival of first catheters group was significantly prolonged in comparison with that of subsequent catheters group [(13.1 ± 3.5) months vs.(11.6±2.7) months,t =2.415,P=0.018].The overall and infection-free survival in WGE group were not different with those of RAR group [(28.2 ± 7.2 ) months vs.( 28.5 ± 5.8 ) months,(11.1±3.1)months vs.(12.2±2.1)months,t=-0.163,0.103,P＞0.05].The infection free survival of first catheters group and WGE group was prolonged in comparison with that of in situ group[(13.1±3.5)months and (11.1±3.1)months vs.(8.2±2.1)months,t =7.602,5.601,P＜0.05].Conclusions WGE is safe and effective in the elderly patients if the tunnel and the exit site are not infected and has the potential benefit of preserving the vascular access site.
