腹膜透析导管腹内段固定联合垂直隧道的低位置管方法的临床应用探讨  

Peritoneal catheter fixation combined with vertical tunnel and low implant position to prevent catheter malfunction

作　　者：张庆燕[1] 蒋春明[1] 孙琤[1] 张苗[1] ZHANG Qing-yan JIANG Chun-ming SUN Cheng ZHANG Miao(Department of Nephrology, Drum Tower Hospital Affiliated to Medical College of Nanjing University, Nanjing 210008, China)

机构地区：[1]南京大学医学院附属鼓楼医院肾脏内科,南京210008

出　　处：《中国血液净化》2017年第1期26-29,共4页Chinese Journal of Blood Purification

基　　金：国家自然科学基金青年科学基金资助项目(81500537)

摘　　要：目的观察腹膜透析(peritoneal dialysis,PD)导管腹内段固定联合垂直隧道的低位置管方法的临床应用价值。方法以2013年1月~2015年9月在南京大学医学院附属鼓楼医院肾脏内科接受PD治疗的终末期肾脏病(end stage renal disease,ESRD)患者为研究对象,入选患者随机采用导管腹内段固定联合垂直隧道的低位置管方法(改良固定方法)或传统置管方法行PD置管并进行PD治疗。观察术后6月期间导管功能障碍、感染、出血、透析液渗漏、进出液疼痛、切口愈合不良、腹外疝等并发症的发生率。结果共99例符合条件的患者进入本研究,其中50例患者采用改良固定方法置管,49例采用传统方法置管,随访期间2组患者腹膜炎(χ~2=1.070,P=0.301)、出口感染/隧道炎(χ~2=0.990,P=0.320)、出血(χ~2=0.990,P=0.320)、透析液渗漏(χ~2=1.031,P=0.310)、进出液疼痛(χ~2=0.000,P=0.984)、腹外疝(χ~2=1.031,P=0.310)、切口愈合不良(χ~2=0.990,P=0.320)等并发症的发生率无统计学差异,改良固定法置管组患者导管功能障碍的发生率显著低于传统置管组(0比16.33%,χ~2=6.819,P=0.009)。结论导管腹内段固定联合垂直隧道的低位PD置管方法可有效减少导管功能障碍的发生,具有临床应用价值。Objective To evaluate the effect of catheter fixation combined with vertical tunnel and low implant position for the prevention of peritoneal catheter malfunction. Methods End stage renal disease（ESRD） patients treated with peritoneal dialysis（PD） in our center from Jan. 2013 to Sep. 2015 were enrolled in this study. They were randomly divided to catheter fixation group and traditional open surgery group, and were followed up for six months after surgery. Catheter-related complications were recorded. Results A total of 99 patients（50 patients in catheter fixation group and 49 patients in traditional open surgery group） were enrolled in this study. During the 6- month follow- up period, no patients in catheter fixation group developed catheter malfunction, significantly lower than that in traditional open surgery group（0 vs. 16.33%, χ^2=6.819,P=0.009）. There were no significant differences in episodes of peritonitis（χ^2=1.070, P=0.301）, exit- site and tunnel infections（χ^2=0.990, P=0.320）, bleeding（χ^2=0.990, P=0.320）, leakage（χ^2=1.031, P=0.310）, inflow or outflow pain（χ^2=0.000, P=0.984）, hernia（χ^2=1.031, P=0.310） and delayed wound healing（χ^2=0.990, P=0.320） between the two groups. Conclusions Catheter fixation combined with vertical tunnel and low implant position can effectively prevent catheter malfunction in PD patients.

关 键 词：腹膜透析 导管功能障碍 导管固定 

分 类 号：R459.5[医药卫生—治疗学]