泵前压比值对透析病人带隧道带涤纶套中心静脉导管功能不良的诊断价值  

Diagnostic value of pre⁃pump pressure ratio for dysfunction of tunnel⁃cuffed catheters in dialysis patients

作　　者：张德生 宋利[2] 蔡晓梅 丁淑贞 尹燕[2] 李卓[2] 华瑞芳 梁华般[2] 刘沛珍[2] 邹根娣 吴晓燕 钟远芳 王伟君 ZHANG Desheng;SONG Li;CAI Xiaomei;DING Shuzhen;YIN Yan;LI Zhuo;HUA Ruifang;LIANG Huaban;LIU Peizhen;ZOU Gendi;WU Xiaoyan;ZHONG Yuanfang;WANG Weijun(Guangdong Provincial People′s Hospital,Ganzhou Hospital,Guangdong 510080 China)

机构地区：[1]广东省人民医院赣州医院(赣州市立医院),广东510080 [2]广东省人民医院(广东省医学科学院) [3]上犹县人民医院 [4]赣县区人民医院

出　　处：《护理研究》2022年第21期3799-3803,共5页Chinese Nursing Research

基　　金：广东省医学科学技术研究基金项目,编号:A2021260;广州市科技计划项目,编号:202102080292。

摘　　要：目的:探讨透析中不同泵控血流量条件下泵前动脉压与泵控血流量比值对透析病人带隧道带涤纶套中心静脉导管(TCC)功能不良的诊断价值。方法:选取3所医院血液透析室179例使用TCC通路的维持性血液透析病人为研究对象,收集病人一般人口学资料、TCC泵前压、泵控血流量、导管功能等临床数据。采用受试者工作特征(ROC)曲线分析泵前压比值诊断TCC功能异常的最佳阈值。结果:179例病人中TCC功能不良发生率为4.47%(8/179),TCC功能一般发生率为8.94%(16/179)。TCC功能正常组、一般组和不良组泵前压比值分别为0.39,0.45,1.31,差异有统计学意义(P<0.001)。将一般组和不良组定义为TCC功能异常事件,ROC曲线分析显示,诊断TCC功能异常的泵前压比值最佳阈值为0.559,敏感度为0.550,特异度为0.930,曲线下面积为0.768,95%CI[0.716,0.820],P<0.001。将泵前压比值≥0.6诊断为TCC功能异常组,将179例病人分为TCC功能异常组(n=26)和正常组(n=153),阳性预测值为55.00%,阴性预测值为93.30%。一致性检验,Kappa值为0.489,Z=6.550,P<0.001。重复测量方差分析显示,随着泵控血流量增加,泵前压比值显著增加(P<0.05)。结论:泵前压比值可用于维持性透析病人TCC功能不良的分级诊断。当透析治疗中TCC泵前压比值持续超过0.6时应查找原因并尽早进行临床护理干预,以防止更严重的导管并发症发生。Objective:To investigate the diagnostic value of the ratio of pre⁃pump arterial pressure to pump⁃controlled blood flow in dialysis patients with dysfunction of tunnel⁃cuffed catheters(TCC)under different pump⁃controlled blood flow conditions.Methods:A total of 179 maintenance hemodialysis patients using TCC in hemodialysis rooms of three hospitals were selected as subjects.General demographic data,TCC pump pressure,pump controlled blood flow,catheter function and other clinical data were collected.The receiver operating characteristic(ROC)curve was used to analyze the optimum threshold for diagnosing abnormal TCC function.Results:Among 179 patients,the incidence of TCC dysfunction was 4.47%(8/179),and incidence of general TCC function was 8.94%(16/179).The ratio of pump front pressure was 0.39,0.45 and 1.31 in the normal,average and poor TCC groups,respectively,with statistical significance(P<0.001).The general group and the average were defined as TCC dysfunction events.ROC curve analysis showed that the optimal threshold for diagnosing TCC dysfunction was 0.559,sensitivity was 0.550,specificity was 0.930,and area under the curve was 0.768,95%CI[0.716,0.820],P<0.001.The pre⁃pump pressure ratio higher than 0.6 identified as abnormal TCC function.A total of 179 patients were divided into TCC dysfunction group(n=26)and normal function group(n=153).The positive predictive value was 55.00%and the negative predictive value was 93.30%.For consistency test,Kappa value was 0.489,Z=6.550,P<0.001.ANOVA of repeated measures showed that the ratio of pre⁃pump pressure increased significantly with the increase of pump controlled blood flow(P<0.05).Conclusion:The pre⁃pump pressure ratio can be used for diagnosis of TCC dysfunction in maintenance dialysis patients.When the TCC pre⁃pump pressure ratio continues to exceed 0.6 during dialysis treatment,the cause should be found and clinical nursing intervention should be carried out as soon as possible to prevent more serious catheter complications.

关 键 词：血液透析 泵前压比值 中心静脉导管 功能不良 预测 调查研究 

分 类 号：R473.5[医药卫生—护理学]