超声稀释法在带隧道带涤纶套导管患者中的临床应用  

The clinical applications of ultrasound dilution in patients with tunneled cuffed catheter hemodialysis

作　　者：王钦 谢勇[2] 余少斌[3] WANG Qin;XIE Yong;YU Shao-bin(Department of Ophthalmology, or Department of Emergency, or Department of Nephropathy, West China. Hospital of Sichuan University, Chengdu 610041, China)

机构地区：[1]四川大学华西医院眼科,成都610041 [2]四川大学华西医院急诊科,成都610041 [3]四川大学华西医院肾脏内科,成都610041

出　　处：《临床肾脏病杂志》2019年第9期668-671,共4页Journal Of Clinical Nephrology

摘　　要：目的探讨超声稀释法(ultrasound dilution,UD)在带隧道带涤纶套导管(tunneled cuffed catheter,TCC)的血液透析(hemodialysis,HD)患者血管通路维护中的临床应用价值。方法纳入2015年1月至2016年2月在华西医院血液透析中心使用TCC作为血管通路规律维持性透析6个月以上,并利用HD02血液透析监测仪行UD评估血管通路的HD患者。记录所有TCC患者循环率(access recirculation,AR)及实际血流量。评估UD方法在TCC再循环率危险因素分析等方面的应用。采用卡方检验比较组间差别,同时进一步采用Logistic多因素回归分析探讨基于HD02监测的TCC患者再循环率的影响因素。结果共纳入TCC患者78例,UD监测分析显示:(1)组间比较结果提示,相比导管反接,导管正接的AR较低,差异有统计学意义[0%(0%~4%)vs.34%(14%~42%),P<0.01]。(2)多元Logistic回归分析提示,TCC患者导管反接与AR独立相关[OR=14.754,95%CI(3.689~59.013)],而透析龄、TCC建立时间、糖尿病因素与AR的关联在多元回归分析中差异无统计学意义(P>0.05)。结论导管反接是引起TCC患者AR的危险因素。基于UD的血管通路监测有助于及时发现血管通路障碍,在HD患者血管通路维护中具有临床应用价值,下一步拟前瞻性队列研究进一步验证本研究结果。Objective To explore the clinical application value of ultrasound Dilution (UD) technology in maintenance of vascular access in patients with tunneled cuffed catheter (TCC) hemodialysis (HD). Methods Those HD patients, who used TCC as the vascular access to conducted regular maintenance hemodialysis for over 6 months in Hemodialysis Center of West China Hospital from January 2015 to February 2016, which was assessed by performing UD with HD02 Hemodialysis Monitoring System, were enrolled in this study. Access recirculation (AR) and actual blood flow in all the patients with TCC were recorded. The application of UD in analysis of risk factors for AR was assessed. Chi-square test was adopted to compare the study groups;at the same time, Logistic multivariate regression analysis was adopted to further explore the influencing factors for TCC patients based on HD02 monitoring. Results A total of 78 patients undergoing HD were finally included.Results from UD monitoring analysis among patients with TCCs:(1) Comparison between groups suggested, compared to reverse catheter connection, AR decreased for normal catheter connection, with difference of statistical significance[0%(0%~4%) vs. 34%(14%~42%), P<0.01].(2)Multivariate logistic regression analysis indicated that, inverse catheter connection in patients with TCC had independent correlation with AR[OR=14.754, 95% CI (3.689~59.013)], while HD years, TCC creation time and diabetic condition had some correlation with AR without difference of statistical significance (P>0.05). Conclusions Inverse catheter connection is a risk factor for AR in patients with TCC. Vascular access monitoring based on UD may help find vascular access failure, and so has value for clinical application to maintenance of vascular access in HD patients. A multi-center prospective cohort study based is on our schedule to further validate the findings from this study.

关 键 词：血液透析 超声稀释法 血管通路 再循环率 带隧道带涤纶套导管 

分 类 号：R692.5[医药卫生—泌尿科学]