摘要
目的探讨尿毒症患者当带隧道带涤纶套导管（tunneled cuffed catheters，TCC）功能不良需更换导管时，采用原位换管方式的可行性，并与常规重新置管方法的比较。方法选择2012年6爿至2014年10月广东医学院附属深圳市第四人民医院肾内科留置带隧道带涤纶套导管2年后出现导管功能不良需更换导管的血液透析患者28例，依据同一部位曾留置导管2次为常规置管组，超过2次为原位换管组，其中常规置管组16例，原位换管组12例；原位换管组采取原位更换导管方式，在涤纶套及上次静脉穿刺点中间位置切开，分离皮下组织后挑起导管，离断并退出远心端，在原导管静脉端置入导丝后退出剩余导管。重新建立一皮下隧道，将新导管从皮下隧道穿过，导丝法置入新导管。与常规重新置管方式比较，观察其年龄、性别、透析时间、曾留置导管次数、血流量、尿素清除指数（Kt／V）、尿素下降率（urea reduction ratio，URR）、置管成功率、感染率、末次置管使用时间等指标，对使用效果进行总结评价。结果常规置管组16例中，6例置管失败；原位换管组12例均成功无手术并发症，术后导管使用通畅，血液透析时血流量达220ml／min以上。术后随访3个月，其中1例在术后1周内出现导管相关性感染，血培养示铜绿假单胞菌，经抗生素静脉治疗及局部封管后好转。统计结果显示，原位换管组在导管血流量、Kt／V值、URR、透析时间、年龄、性别上与常规置管组无统计学差异（P〉0．05）。患者同部位血管曾换管次数越多，末次置管使用时间越长，需要使用原位换管的可能性越大，原位换管组术后导管相关性感染发生率较常规置管组高（P〈0．05）。结论对于血液透析带隧道带涤纶套导管出现功能不良的尿毒症患者，采用原位换管方式，可明显提高手术成功率，是有效实用
Objective To explore the efficacy of in situ replacement of a tunneled cuffed catheter （TCC） by comparing with the method of re-catheterization of TCC in a separate site in chronic hemodialysis patients. Methods A total of 28 patients receiving chronic hemodialysis with dysfunctional TCCs 2 years after catheterization were included in this study. All participants received a new TCC insertion by the method of re-catheterization of the TCC in a separate site （n = 16） or replacement of the TCC in situ （n = 12）. Efficacy of indwelling TCCs, complications related to insertion, and patients＇ characteristics were compared in these two groups of patients by the different method of catheterization. Results Six cases of failing to insert a TCC were seen in patients who received re-catheterization of TCC in a separate site （6/16）. In patients who received replacement of TCC in situ, all insertions were successful with catheter blood flow more than 220 ml/min and without any complication. There was no statistically significant difference in catheter blood flow, Kt/V, URR, dialysis duration, and patients＂ demographics between these two groups of patients with different catheterization methods.After a 3-month follow-up, the rate of catheter related infection after insertion was higher in patients who received replacement TCC in situ than those who received re-catheterization of TCC in a separate site （P〈0. 05）. Conclusions In situ replacement of a TCC is an efficient method to treat a dysfunctional catheter in patients on chronic hemodialysis. Caution should he taken to reduce the rate of infection during catheterization.
出处
《临床肾脏病杂志》
2015年第10期608-611,共4页
Journal Of Clinical Nephrology
关键词
血液透析
带隧道带涤纶套导管
原位换管
hemodialysis
tunneled cuffed catheter
in situ replacement catheter
