隧道式血透导管在右颈外静脉与左颈内静脉应用比较的回顾性研究

发布时间：2018-11-22 09:35

【摘要】：背景与目的血管通路是血液透析患者的生命线,一个功能良好的血管通路是血液透析患者赖以维持生命的前提条件。自体动静脉内瘘是血液透析患者的首选通路,但当自体动静脉内瘘尚未成熟或功能不良,患者或者不能承受人工血管内瘘的高昂费用时,隧道式血液透析导管就成为主要的代替方式。右颈内静脉是导管置入的首选部位,而对于那些由于各种原因所致右颈内静脉严重血栓或者闭塞者,右颈外静脉和左颈内静脉均是可供选择的备选置管部位。本回顾性研究选择右颈内静脉无法作为正常穿刺入路的患者,观察隧道式血液透析导管在右颈外静脉和左颈内静脉这两个备选部位的临床差异。方法自2013年01月01日至2014年12月31日在我院接受隧道式血液透析导管置入术的患者中,筛选出其中经右颈外静脉置入导管患者(n=21)及左颈内静脉置入导管患者(n=28)共计49例,随访至2015年03月31日。观察主要终点为导管累积通畅时间,次要终点包括导管初始通畅时间、从未使用尿激酶的患者比例以及导管相关血流感染的发生率。患者基线资料分析定量变量采用独立样本t检验或Wilcoxon秩和检验,分类变量采用卡方检验。两组导管累积通畅时间和导管初始通畅时间采用采用Kaplan-Meier法。应用Cox比例风险回归模型探究导管长期通畅的独立影响因素。数据分析应用软件SPSS 22.0完成。选取α=0.05为检验水准。结果1.两组共观察到20,870带导管天数,带导管天数的中位数为384(四分位数间距,262-605)天;2.右颈外静脉组比左颈内静脉组更少出现导管拔除事件(P=0.007);3.右颈外静脉组的平均导管累积通畅时间相比左颈内静脉组更长(P=0.031);4.两组间在导管相关血流感染、导管初始通畅时间以及从未使用尿激酶患者的比例方面均无明显统计学差异;5.应用Cox比例风险回归模型发现既往导管累积留置时间为影响导管累积通畅时间的独立危险因素(HR=2.212;95%CI,1.363 3.588;P=0.001)结论对于右颈内静脉无法使用的血液透析患者,如需再次进行隧道式透析导管置入,选用右颈外静脉比左颈内静脉有更好的临床预后,更适合作为隧道式血透导管置入的第二选择通路。
[Abstract]:Background and objective the vascular pathway is the lifeline of hemodialysis patients, and a well-functioning vascular pathway is the prerequisite for the maintenance of life for hemodialysis patients. Autogenous arteriovenous fistula is the first choice for hemodialysis patients, but when autologous arteriovenous fistula is immature or dysfunctional, the patient may not be able to afford the high cost of artificial vascular fistula. Tunneling hemodialysis catheters are the main alternative. The right internal jugular vein is the first place of choice for catheterization, but for those with severe thrombosis or occlusion of right internal jugular vein due to various reasons, right external jugular vein and left internal jugular vein are the alternative catheterization sites. This retrospective study selected patients with right internal jugular vein who could not be used as the normal puncture approach to observe the clinical differences between the right external jugular vein and the left internal jugular vein in the tunnel hemodialysis catheter. Methods from January 01, 2013 to December 31, 2014, the patients underwent tunneling hemodialysis catheter placement in our hospital. A total of 49 patients with catheterization via right external jugular vein (N21) and left internal jugular vein (NM28) were selected and followed up to March 31, 2015. The main endpoints were cumulative patency time, secondary endpoints included the initial patency time, the proportion of patients who had never used urokinase, and the incidence of catheter-related blood flow infection. Patient baseline data were analyzed by independent sample t test or Wilcoxon rank sum test, and classified variables by chi-square test. The cumulative patency time and the initial patency time were measured by Kaplan-Meier method. The Cox proportional risk regression model was used to explore the independent influencing factors of long-term patency of ducts. Data analysis application software SPSS 22. 0 is completed. 伪 = 0.05 was selected as the test level. Result 1. A total of 20870 catheterized days were observed in the two groups, and the median number of days with catheterization was 384 (quartile spacing, 262-605) days; 2. The right external jugular vein group had fewer extubation events than the left internal jugular vein group (P0. 007). The mean cumulative patency time of the right external jugular vein group was longer than that of the left internal jugular vein group (P < 0.031). There was no significant difference between the two groups in catheter-related blood flow infection, the initial patency time of catheter and the proportion of patients who had never used urokinase. The Cox proportional risk regression model was used to find that the cumulative indwelling time was an independent risk factor for the cumulative patency time of the catheter (HR=2.212;95%CI,1.363 3.588). Conclusion for hemodialysis patients whose right internal jugular vein cannot be used, the right external jugular vein is better than the left internal jugular vein if the tunnel dialysis catheter is needed again. It is more suitable as the second choice of tunnel hemodialysis catheter.
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R692.5

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