血液透析患者长期血透导管拔管原因的回顾性分析  

A retrospective analysis of the causes of long-term hemodialysis catheter extubation in hemodialysis patients

作　　者：曾艳[1] 陈友明[1] ZENG Yan;CHEN You-ming(Department of Blood Purification,Fujian Provincial Hospital,Fuzhou350001,China)

机构地区：[1]福建省立医院血液净化科,福建福州350001

出　　处：《中国当代医药》2020年第31期200-204,共5页China Modern Medicine

摘　　要：目的探讨血液透析患者长期血透导管拔管的原因。方法对福建省立医院2013年8月~2018年8月因导管丧失功能(以下简称“失功”)拔除长期血透导管的66例患者进行回顾性分析,采用系统抽样法获得66例导管功能正常患者为对照组,收集两组的一般资料及实验室资料为观察项目,通过二元Logistic回归方程分析失功拔管的相关危险因素。结果符合入组标准的有419例,失功拔管率15.75%。主要失功原因为:导管功能不良、导管感染及导管脱出,分别占48.48%、24.24%及21.21%。单因素分析结果提示:失功拔管组和对照组的年龄、血流量、血栓史阳性、血白蛋白、总胆固醇、脂蛋白a、二氧化碳结合力、C反应蛋白比较,差异有统计学意义(P<0.05)。多因素分析结果提示,年龄(β=0.053,OR=1.062,95%CI=1.007~1.120)、C反应蛋白(β=0.057,OR=1.054,95%CI=1.011~1.098)、血流量(β=-0.034,OR=0.968,95%CI=0.944~0.993)、脂蛋白a(β=0.003,OR=1.003,95%CI=1.000~1.565)属于相关因素(P<0.05)。其中年龄、CRP的OR>1,血流量的OR<1,则考虑高龄、高CRP、低血流量为导管失功的独立危险因素;脂蛋白a的OR>1,但95%可信区间包含1,则考虑高脂蛋白a可能为独立危险因素。结论高龄、高CRP为长期导管失功的独立危险因素,血流量是一个重要参考因素,脂蛋白a具有进一步研究的重要意义。其中C反应蛋白的意义最为明确,有进行长期连续监测的必要。Objective To explore the causes of long-term hemodialysis catheter extubation in hemodialysis patients.Methods A retrospective analysis of 66 patients with long-term hemodialysis catheters removed due to catheter loss(hereinafter referred to as"loss of function")in Fujian Provincial Hospital from August 2013 to August 2018.The system sampling method was adopted to obtain 66 patients with normal catheter function for the control group.The general data and laboratory data of the two groups were collected as observation items.The observation items were analyzed by the statistical method to sum up the relevant risk factors of the extubation.Results There were 419 cases who met entry criteria and the rate of out-of-work extubation was 15.75%.The main causes of the out-of-work were that the function of the catheter was not good,the infection of the catheter and the withdrawal of the catheter,and the rates were 48.48%,24.24%and 21.21%respectively.The results of univariate analysis showed that there were statistically significant differences in age,blood flow,thrombotic history,serum albumin,total cholesterol,lipoprotein a,carbon dioxide binding capacity,and C-reactive protein between the failure extubation group and the control group(P<0.05).The results of multivariate analysis suggested that age(β=0.053,OR=1.062,95%CI=1.007-1.120),C-reactive protein(β=0.057,OR=1.054,95%CI=1.011-1.098),blood flow(β=-0.034,OR=0.968,95%CI=0.944-0.993),lipoprotein a(β=0.003,OR=1.003,95%CI=1.000-1.565)were related factors(P<0.05).Among them,the OR of age and CRP were greater than 1,and the OR of blood flow was less than 1,for catheter failure,advanced age,high CRP,and low blood flow were considered as the independent risk factors;the OR of lipoprotein a was greater than 1,but the 95%confidence interval included 1,so high lipoprotein a was considerd as an independent risk factor.Conclusion Advanced age and high CRP are independent risk factors for long-term catheter failure,and blood flow is an important reference factor,and lipoprotein

关 键 词：血液透析 中心静脉导管 长期血透导管 带隧道带涤纶套导管 

分 类 号：R692.5[医药卫生—泌尿科学]