经食管超声在带隧道和涤纶套的血液透析导管功能不良中的应用  

Application of transesophageal echocardiography for hemodialysis tunneled cuffed catheter dysfunction

作　　者：王蕴若 吴悠 徐杜娟[3] 刘茹[3] 牛苏 Wang Yun-ruo;Wu You;Xu Du-juan;Liu Ru;Niu Su(Department of Nephrology,Central Municipal Hospital,Xuzhou 221009,China;Nanjing University of Traditional Chinese Medicine,Nanjing 210023,China;Department of Ultrasonography,Central Municipal Hospital,Xuzhou 221009,China;Department of Intervention,Central Municipal Hospital,Xuzhou 221009,China)

机构地区：[1]徐州市中心医院肾内科,徐州221009 [2]南京中医药大学,南京210023 [3]徐州市中心医院超声科,徐州221009 [4]徐州市中心医院介入科,徐州221009

出　　处：《临床肾脏病杂志》2024年第9期712-719,共8页Journal Of Clinical Nephrology

摘　　要：目的探讨经食管超声(transesophageal echocardiography,TEE)在带隧道和涤纶套的血液透析导管(tunneled cuffed catheter,TCC)功能不良评估中的应用价值。方法纳入2020年3月1日至2022年7月31日徐州市中心医院收治的以TCC行血液透析并出现导管功能不良,同时行TEE和数字减影血管造影(digital subtraction angiography,DSA)的患者28例,观察导管走行,有无血栓、纤维蛋白鞘和中心静脉狭窄等。TEE或DSA阳性标准为至少出现以下一种情况:(1)导管相关血栓形成(catheter-related thrombosis,CRT);(2)导管周围纤维蛋白鞘;(3)中心静脉狭窄;(4)腔房交界处狭窄;(5)导管位置不当。以DSA为金标准,分析TEE检查结果的灵敏度、特异度、正确率、阳性预测值和阴性预测值;受试者工作特征(receiver operating characteristic,ROC)曲线和曲线下面积(area under curve,AUC),分析TEE检查的准确性;采用Kappa检验分析TEE与DSA两种检查结果的一致性。结果28例患者中TEE阳性18例,DSA阳性16例,TEE与DSA检查结果比较,灵敏度为87.5%,特异度为66.7%,正确率为78.6%,阳性预测值为77.8%,阴性预测值为80%,AUC为0.771(95%CI:0.582~0.960),P=0.016;Kappa=0.553,P=0.003,说明TEE与DSA检查结果存在一致性的情况。结论TEE是评估TCC功能不良的重要手段,具有无创、经济、方便易行等优点,对指导TCC功能不良的诊治有重要作用,具有推广价值。Objective To explore the application value of transesophageal echocardiography(TEE)for evaluating hemodialysis tunneled cuffed catheter(TCC)dysfunction.Methods From March 1,2020 to July 31,2022,28 patients hospitalized at Central Municipal Hospital for hemodialysis with tunneled cuffed catheter(TCC)dysfunction.Both TEE and digital subtraction angiography(DSA)were performed for observing the status of catheter routing,thrombus,fibrin sheath and central venous disease,etc.Positive criteria for TEE/DSA if one or more of the following:(1)catheter-related thrombosis(CRT);(2)fibrin sheath around duct;(3)central venous stenosis;(4)narrow chamber junction;(5)catheter in an inappropriate position.With DSA as a gold standard,sensitivity,specificity,accuracy,positive predictive value and negative predictive value of TEE results were analyzed.Receiver operating characteristic(ROC)curve and area under ROC curve(AUC)were employed for examining the accuracy of TEE and verifying the consistency of two inspection results.Results Among them,18 were TEE positive and 16 DSA positive.As compared with DSA results,TEE had a sensitivity of 87.5%,a specificity of 66.7%,an accuracy of 78.6%,a positive predictive value of 77.8%and a negative predictive value of 80%.AUC of 0.771[95%CI(0.582,0.960),P=0.016;Kappa=0.553,P=0.003]hinted at consistency between TEE/DSA results.Conclusion As an important modality of evaluating TCC dysfunction,TEE offers the advantages of noninvasiveness,affordability and convenience.It may guide the diagnosis and treatment of TCC dysfunction and is worthy of wider popularization.

关 键 词：带隧道和涤纶套的血液透析导管 导管功能不良 血液透析 

分 类 号：R445.1[医药卫生—影像医学与核医学] R692.5[医药卫生—诊断学]