CAJ | 학술논문

目的：探讨带隧道和涤纶套的长期导管(简称长期导管)在血液透析中的应用及常见并发症的处理,比较 Palindrom 导管与普通(Permcath)导管的应用效果。方法回顾性分析2008年6月至2014年8月我院留置的157例长期导管置管和使用中的并发症和处理对策,选取2012年8月至2014年8月采用 Palindrom 导管47例与普通导管35例,观察2组平均血流量、尿素清除率(Kt/v)、尿素下降率(urea reduction ratio,URR),比较2组功能不良及感染的发生率。结果置管成功率100%。随访中非导管相关死亡31例,失访13例,余下113例平均留置时间(19.6±15.7)个月,最长69个月,最短107 d。置管出现渗血6例,导管成角2例、心悸2例,导丝送入困难2例。导管使用中并发症39例：功能不良占16.81%,感染占15.04%,卡夫脱出占1.77%,管头裂缝占0.88%。2012年8月至2014年8月共置管83例次,Palindrom 导管47例次,功能不良16例次,平均发生率为1.23/1000导管日,发生感染2例次,平均感染率为0.13次/1000导管日,拔管0例；普通导管36例次,功能不良47例次,平均发生率为6.33次/1000导管日,感染9例次,平均感染率1.16次/1000导管日,1例反复感染后换 Palindrom 管。Palindrom 导管组平均感染率、功能不良发生率均低于普通导管组,平均血流量、Kt/v、URR 指标优于普通导管组,差异均有统计学意义。结论充分的术前准备、熟练地操作技术和良好的导管维护是导管留置成功、导管长期使用及减少导管使用并发症的关键。在长期导管的临床应用中,Palindrom 导管比 Permcath 导管更具优势。
목적：탐토대수도화조륜투적장기도관(간칭장기도관)재혈액투석중적응용급상견병발증적처리,비교 Palindrom 도관여보통(Permcath)도관적응용효과。방법회고성분석2008년6월지2014년8월아원류치적157례장기도관치관화사용중적병발증화처리대책,선취2012년8월지2014년8월채용 Palindrom 도관47례여보통도관35례,관찰2조평균혈류량、뇨소청제솔(Kt/v)、뇨소하강솔(urea reduction ratio,URR),비교2조공능불량급감염적발생솔。결과치관성공솔100%。수방중비도관상관사망31례,실방13례,여하113례평균류치시간(19.6±15.7)개월,최장69개월,최단107 d。치관출현삼혈6례,도관성각2례、심계2례,도사송입곤난2례。도관사용중병발증39례：공능불량점16.81%,감염점15.04%,잡부탈출점1.77%,관두렬봉점0.88%。2012년8월지2014년8월공치관83례차,Palindrom 도관47례차,공능불량16례차,평균발생솔위1.23/1000도관일,발생감염2례차,평균감염솔위0.13차/1000도관일,발관0례；보통도관36례차,공능불량47례차,평균발생솔위6.33차/1000도관일,감염9례차,평균감염솔1.16차/1000도관일,1례반복감염후환 Palindrom 관。Palindrom 도관조평균감염솔、공능불량발생솔균저우보통도관조,평균혈류량、Kt/v、URR 지표우우보통도관조,차이균유통계학의의。결론충분적술전준비、숙련지조작기술화량호적도관유호시도관류치성공、도관장기사용급감소도관사용병발증적관건。재장기도관적림상응용중,Palindrom 도관비 Permcath 도관경구우세。
Objective To explore the complications and their treatment in long-term indwelling cuffed tunneled catheter in chronic dialysis access.Dialysis effect and complications were observed and compared between patients with palindrome catheter group and those with non-palindrome catheter group.Methods We retrospectively reviewed 1 57 patients with long-term indwelling catheterization in deep vein for hemodialysis(HD)blood access from July 2008 to Aug.2014 in our center,and analyzed the complications due to the catheterization and their management.Forty-seven cases using Palindrom catheter and 36 cases using a common catheter in the last two years were selected.The average blood flow,urea clearance(Kt/v)and urea descent rate(URR)were observed.The incidence of dysfunction and infection was compared.Results The operation for central venous catheterization was successful in patients.There were 3 1 catheterization-unrelated deaths during the follow-up period,and 13 patients lost follow-up.The average indwelling period of the catheters was(19.6±1 5.7)months (107 days to 69 months)in the rest of 1 13 patients.The major complications during the catheterization included er-rhysis in 6 cases,palpitation in 2 cases,angled torsion of the catheter in 2 cases and difficult-ties of the guide wire to enter blood vessels in 2 cases.Complications in the blood access for hemodialysis pe-riod occurred in 39 cases,including dysfunction(16.81 %),local infection (1 5.04%),out off cuff of the catheter(1 .77%)and cracks in the head of the catheter (0.88%).There were 83 times of cathe-terization from August 2012 to August 2014.In palindrome catheter group(n =47),dysfunction oc-curred in 16 cases(1 .23 times/1 000 catheter-days),and infection 2 times(0.13 times/1 000 catheter-days),and none of the catheters were finally removed.In non-palindrome catheter group (n =36), dysfunction occurred 47 times(6.33 times/1 000 catheter-days),and infection 9 times(1 .16 times/1 000 catheter-days).One case was converted to Palindrom tube after repeated infections.The infection rate in Palindrom catheter group was lower than that in control group.The average infection and dys-function rate in Palindrom catheter group was lower than that in control group.The average blood flow,Kt/v,and URR indicators were better in Palindrom catheter than in control group.There was statistically significant difference between the two groups.Conclusions Sufficient preoperative prepa-ration,proficient operative technology and good catheter maintenance are the key for catheter indwell-ing success,long-term use and reduction of the complications.Palindrome dialysis catheter is a better device for chronic HD patients than the ordinary catheter.