血液透析患者永久性中心静脉插管长度对导管功能的影响  

The influence of the length of chronic central venous catheter on catheter dysfunction in hemodialysis patients

作　　者：杨涛[1] 张丽红[1] 詹申 李大胜[2] 王玉柱[1] 

机构地区：[1]北京市海淀医院肾内科,北京100080 [2]北京市海淀医院放射科,北京100080

出　　处：《中国血液净化》2011年第10期527-530,共4页Chinese Journal of Blood Purification

摘　　要：目的探讨不同长度永久性中心静脉置管导管功能不良的发生率,寻找导致导管功能不良的影响因素。方法 231名终末期肾病患者,采用右侧颈内静脉中心静脉置管,置管后摄正位胸片。根据管路长度分为36cm组、40cm组及45cm组。观察年龄、身高、体质量、管路末端位置、血红蛋白、血小板、白蛋白及是否患有糖尿病及冠心病对导管功能不良发生的影响,比较不同长度管路血流量及导管功能不良发生率的差异。结果 3组患者透析泵控血流量分别为[(254.4±30.6)ml/min,(257.7±23.1)ml/min,(253.0±28.0)ml/min,P=0.603];3组导管功能不良发生比例行卡方检验差别无统计学意义(P=0.715);管路末端在心房者与不在心房者导管功能不良的发生率差异无统计学意义(P=0.280)。Logistic回归提示血红蛋白(OR=1.037,P=0.002)、白蛋白(OR=0.922,P=0.041)及身高(OR=0.910,P=0.002)为导管功能不良发生的影响因素。结论身高、血红蛋白与血清白蛋白水平是透析患者永久性中心静脉导管功能不良的影响因素,但管路长度并不是其影响因素。Objective To investigate catheter dysfunction in relation to the length of chronic central venous catheter in hemodialysis patients, and to explore the factors relating to the dysfunction. Methods We recruited 231 end stage renal disease patients inserted a catheter into right internal jugular veins for vascular access. X-ray chest film was taken to determine the catheter tip position. They were then assigned into 3 groups （36 cm, 40 cm, or 45cm groups） based on the catheter length placed in the body. Their age, body height, hemoglobin （Hb）, platelet （Plt）, activated partial thromboplastin time （APTT）, albumin （Alb） and disease history such as diabetes mellitus and coronary heart disease were collected. Arrhythmia during dialysis using the catheter was also recorded. Catheter dysfunction rate was compared among the 3 groups. Logistic regression was used to evaluate the factors relating to catheter dysfunction. Results Blood flow during hemodialysis was 254.4±30.6ml/min, 257.7±23.1ml/min and 253.0±28.0ml/min in the 36cm, 40cm and 45cm groups （P = 0.603）, respectively. Statistical difference in catheter dysfunction rate was not found among the 3 groups （P = 0.715） nor between the patients with the catheter tip in atrium and those outside the atrium （P=0.280）. Logistic regression indicated that hemoglobin, albumin and body height were the factors relating to catheter dysfunction in hemodialysis patients with the odds ratio of 1.037 （P=0.002）, 0.922 （P=0.041） and 0.910 （P=0.002）, respectively. Conclusion Hemoglobin, albumin and body height are the influence factors on catheter dysfunction, but catheter length is unrelated to catheter dysfunction in hemodialysis patients

关 键 词：血液透析 永久性中心静脉导管 导管长度 功能不良 

分 类 号：R318.16[医药卫生—生物医学工程]