双涤纶套鹅颈管与Tenckhoff管在腹膜透析患者中的疗效比较  

Prospective efficacy comparison between the two-cuff swan neck catheter and the Tenckhoff catheter in peritoneal dialysis patients

作　　者：谢静远[1] 朱萍[1] 沈平雁[1] 任红[1] 黄晓敏[1] 李晓[1] 陈晓农[1] 陈楠[1] 

机构地区：[1]上海交通大学医学院附属瑞金医院肾脏科, 210025

出　　处：《中华肾脏病杂志》2008年第10期685-689,共5页Chinese Journal of Nephrology

基　　金：上海市重点学科建设基金（T0201）;上海市卫生局重点学科建设基金（05111001）;上海市卫生局重点课题（2003ZD002）

摘　　要：目的比较双涤纶套鹅颈管与Tenckhoff管在持续性非卧床腹膜透析（CAPD）患者中的临床疗效。方法前瞻性入选首次植管并接受CAPD治疗的终末期肾脏病（ESRD）患者110例，随机分为鹅颈管组（A组）和Tenckhoff管组（B组），各55例。腹透管末端均为直型，以常规手术法植入，随访1年。记录并发症、生存时间、退出透析或死亡等结局。采用Kaplan—Meier法、Log—Rank柃验进行生存分析。结果随访结束时，110例CAPD患者中17例死亡，3例转为肾移植，8例转为血液透析治疗，3例转至其他医院，79例（71．8％）继续在我院腹透治疗。两组患者共发生腹膜炎26例（35例次），总腹膜炎发生率为0．32次／病人年，A组为0．35次／病人年和B组为0．29次／病人年（P〉0．05）。植管距离首次腹膜炎时间分别为A组（30~29）周和B组（29±4）周（P〉0．05）。12个月时两组发生腹膜炎的风险同为26．97％。两组共发生隧道感染2次，出口感染9次，隧道及出口感染的发生率为0．1次／病人年。与A组比较，B组隧道感染（0．036次／病人年比0）和出口感染（0．11次／病人年比0．06次／病人年）发生率较高，但差异无统计学意义（P〉0．05）。两组间导管机械并发症（导管移位、大网膜包裹、腹透液渗漏、外涤纶套滑出）、腹股沟疝及腹痛的发生率差异均无统计学意义（P〉0．05）。两组各有4例拔管，12个月技术生存率两组同为92．73％。两组共17例死亡（15．45％），其中A组死亡7例，B组死亡10例（P〉0．05），死亡原因主要为心脑血管并发症（47．1％）和感染（23．5％）。患者12个月生存率A组为86．34％，B组为80．68％（P〉0．05）。结论鹅颈管与Tenckhoff管应用于CAPD患者，在感染并发症与机械并发症的发生率、12个月技术生存率及患者生存率等方面的差异均无统计学意义，两种腹透管的疗�Objective To compare the efficacy between the two-cuff swan neck catheter and the Tenckhoff catheter in continuous ambulatory peritoneal dialysis （CAPD） patients prospectively. Methods One hundred and ten patients with end-stage renal disease （ESRD） were selected as candidates, who received catheter implantation and CAPD therapy for the first time. Patients were divided into group A （swan neck catheter group） and group B （Tenckhoff catheter group）, 55 patients for each group. Catheters of both groups had a straight end and were implanted by routine surgical procedure. One-year follow-up was performed and information was recorded such as complications, survival time, quit of dialysis, death, etc. Survival analysis was carried out by Kaplan-Meier method and Log-Rank tests. Results At the end of follow-up, 17 patients died, 3 received renal transplantation, 8 were transferred to hemodialysis, 3 went to other hospitals, and 79 patients （71.8%） remained in our department for CAPD. Twenty-six patients of both groups had peritonitis with a total of 35 occurrences. The total incidence of peritonitis was 0.32 times/patient year, with the detailed figure of 0.35 times/patient year for group A and 0.29 times/patient year for group B respectively （P〉0.05）. The time interval between the catheter implanting and the onset of peritonitis was （30±29） weeks and （29±24） weeks for group A and group B respectively （P〉0.05）. The risk of developing peritonitis in both groups was 26.97% within 1 year. Tunnel infection occurred in 2 patients and exit-site infections in 9 patients of two groups. The incidence of tunnel plus exit-site infections was 0.1 times/patient year. Incidence of tunnel infection and the exit-site infection for group A was lower than that of group B （0 vs 0.036 times/patient year and 0.06 times/patient year vs 0.11 times/patient year respectively）. However, the difference was not significant （P〉0.05）. Mechanical complications of catheter （catheter migration, oment

关 键 词：腹膜透析 持续不卧床 导管 留置 存活率分析 鹅颈管 Tenckhoff腹透管 

分 类 号：R459.5[医药卫生—治疗学] R683.42[医药卫生—临床医学]