腹腔置管引流治疗肝硬化顽固性腹水的效果及脱管的影响因素分析  

The Effect of Abdominal Catheterization in the Treatment of Refractory Ascites and Analysis of Influencing Factors of Tube Falling

作　　者：步光奎 廖江涛[1] BU Guangkui;LIAO Jiangtao(Hunan Provincial People's Hospital/First Affiliated Hospital of Hunan Normal University,Hunan Changsha 410016,China)

机构地区：[1]湖南省人民医院/湖南师范大学附属第一医院消化三科,湖南长沙410016

出　　处：《河北医学》2021年第9期1522-1526,共5页Hebei Medicine

基　　金：湖南省技术创新引导计划-临床医疗技术创新引导项目,(编号:2017SK50523)。

摘　　要：目的:探讨腹腔留置中心静脉导管治疗肝硬化顽固性腹水的疗效,分析脱管的影响因素。方法:回顾性分析2015年1月至2019年1月我院96例行腹腔留置中心静脉导管治疗的肝硬化顽固性腹水患者临床资料,评价分析腹腔留置中心静脉导管对肝硬化顽固性腹水的治疗效果。根据置管后是否出现脱管将患者分为脱管组和未脱管组,分析脱管的影响因素。结果:置管后患者腹胀缓解总有效率为90.63%;置管前后白细胞、血小板、谷丙转氨酶、谷草转氨酶、总胆红素、间接胆红素、肌酐、凝血酶原时间、降钙素原无明显差异(P>0.05),白蛋白较置管前升高,差异有统计学意义(P<0.05);腹水外渗、脱管、堵管、感染不良事件发生率为22.92%;多元Logistic回归分析发现导管缝皮固定为脱管的保护因素(OR=0.336);腹水外渗(OR=3.961)、腹水量(OR=1.732)、导管留置时间(OR=3.219)是脱管的危险因素。结论:腹腔留置中心静脉导管可有效缓解肝硬化顽固性腹水患者腹胀症状,且不影响患者血常规、肝肾功能、凝血功能;导管缝皮固定、腹水外渗、腹水量、导管留置时间为腹腔留置中心静脉导管脱管的影响因素。Objective:To investigate the efficacy of abdominal indwelling central venous catheter in the treatment of refractory ascites,and to analyze the influencing factors of tube falling.Methods:A total of 96 cirrhotic with refractory ascites patients who received abdominal indwelling central venous catheter drainage ascites from January 2015 to January 2019 were retrospectively analyzed.The efficacy of central venous catheter in the treatment of refractory ascites were evaluated.Then,the patients were divided into a tube falling group and non-tube falling group,and influencing factors about tube fell out were analyzed.Results:The total effective rate of abdominal distension after indwelling central venous catheter was 90.63%.There were no significant differences in white blood cells,platelets,alanine aminotransferase,aspartate aminotransferase,total bilirubin,indirect bilirubin,creatinine,prothrombin time,and procalcitonin before and after tube placement(P>0.05).Albumin was higher than that before tube placement(P<0.05).The incidence of adverse events was 22.92%.Multivariate logistic regression analysis found that the catheter suture fixation as a protective factor for tube falling(OR=0.336).Ascites extravasation(OR=3.961),ascites volume(OR=1.732),catheter indwelling time(OR=3.219)were the risk factors of tube falling.Conclusion:Abdominal indwelling central venous catheter can effectively relieve the symptoms of abdominal distension in patients with refractory ascites due to cirrhosis,and does not affect the blood routine,liver and kidney function,and blood coagulation function.Catheter suture fixation,ascites extravasation,ascites volume,catheter indwelling time are influencing factors of tube fell out.

关 键 词：腹腔置管 肝硬化 顽固性腹水 脱管 影响因素 

分 类 号：R575.2[医药卫生—消化系统]