对形成纤维蛋白鞘的带涤纶套和隧道透析导管的更换方式探索  

Catheter Replacement Methods in Hemodialysis Patients With Dysfunctional Tunneled-Cuffed Catheters WithFibrin Sheaths

作　　者：金骊珠[1,2] 王慧 崔天蕾[1] 廖若西[1] JIN Lizhu;WANG Hui;CUI Tianlei;LIAO Ruoxi(Department of Nephrology,West China Hospital,Sichuan University,Chengdu 610041,China;Department of Nephrology,The Third People's Hospital of Chengdu,Chengdu 610014,China;Department of Cardiology,West China Hospital,Sichuan University,Chengdu 610041,China)

机构地区：[1]四川大学华西医院肾脏内科,成都610041 [2]成都市第三人民医院肾脏内科,成都610014 [3]四川大学华西医院心脏内科,成都610041

出　　处：《四川大学学报（医学版）》2023年第6期1283-1287,共5页Journal of Sichuan University(Medical Sciences)

基　　金：国家自然科学基金青年基金(No.8200702)资助。

摘　　要：目的 带涤纶套和隧道的透析导管(tunneled-cuffed catheter, TCC)是老年、外周血管资源差的维持性透析患者重要的透析通路,长期的导管留置会形成纤维蛋白鞘包裹管周并影响导管功能。本研究拟通过比较球囊扩张协助鞘外换管和原位换管两种方式的预后,以探索更优的导管更换流程。方法 回顾性分析本中心52例更换TCC的病例,其中27例采用改良方式(鞘外组)更换导管,25例原位换管(原位组)。主要结局指标为随访1、3、6个月透析导管最大血流量及尿素清除指数(urea clearance index, Kt/V)值,次要结局为随访中透析器报警和导管相关感染。结果 两组间在一般情况方面差异无统计学意义,手术均无大出血、心包填塞、导管相关感染等相关并发症发生。随访1、3、6个月,鞘外组与原位组相比,导管第6个月血流量更大[(241.85±9.62) mL/min vs.(234.40±11.21) mL/min,P=0.014]、Kt/V值更高(1.31±0.55 vs.1.27±0.49, P=0.005)。随访过程中,共5例患者出现透析过程中通路报警(原位组3例,鞘外组2例),两组患者均未发生导管相关感染。结论 通过球囊扩张协助鞘外换管的方式安全、有效,与原位更换导管相比,其长期导管血流量更佳。Objective Tunneled-cuffed catheters(TCCs)are frequently used for establishing hemodialysis access for maintenance hemodialysis in older patients with exhausted resources of peripheral vessels.Fibrin sheath formation around the catheter is one of the most common complications of long-term use of indwelling catheter,which may cause the malfunction of the catheter.In this study,we intend to compare the prognosis of two catheter replacement methods,in situ replacement and replacement through a fibrin sheath crevice,with both being assisted by balloon dilation,and to explore the optimal catheter replacement process.Methods A retrospective study was conducted with 52 patients who underwent a replacement of their TCCs.Among them,27 cases had their TCC replaced by the modified method of replacement through a fibrin sheath crevice and were referred to as the sheath crevice group,while 25 cases underwent in situ catheter replacement and were referred to as the in situ group.The primary outcome indicators included maximum blood flow in hemodialysis catheter and the urea clearance rate calculated by Kt/V values at the 1,3,and 6-month follow-ups.The secondary outcomes included dialyzer alarms being set off and catheter-related infections during follow-up.Results There was no significant difference between the general data of the two groups.There was no massive blood loss during the replacement procedure.Neither were there cardiac tamponade,catheter-associated infections,or other complications.Follow-ups were made 1,3,and 6 months after the replacement procedure.The sheath crevice group had higher catheter blood flow and Kt/V values at the 6-month follow-up than the in situ group did([241.85±9.62]mL/min vs.[234.40±11.21]mL/min,P=0.014 and 1.31±0.55 vs.1.27±0.49,P=0.005,respectively).During the follow-up process,access alarms were reported in 5 patients(three in the in situ group and two in the sheath crevice group)during dialysis.No catheter-associated infection occurred in either group.Conclusion The catheter replacement

关 键 词：血液透析 血管通路 球囊扩张 纤维蛋白鞘 回顾性分析 临床对照研究 

分 类 号：R692.5[医药卫生—泌尿科学]