颈内静脉带涤纶套隧道型血液透析导管置入后中心静脉病变的危险因素分析  

Analysis of risk factors for central venous disease after placement of tunneled cuffed catheter in the internal jugular vein

作　　者：苏朝江 姜燕 刘俪婷 熊智倩 司马重阳 陈彦 刘宗旸 Su Chaojiang;Jiang Yan;Liu Liting;Xiong Zhiqian;Sima Chongyang;Chen Yan;Liu Zongyang(Department of Nephrology,Cancer Hospital Affiliated to Guizhou Medical University,Guiyang 550003,Guizhou,China;School of Clinical Medicine,Guizhou Medical University,Guiyang 550004,Guizhou,China)

机构地区：[1]贵州医科大学附属肿瘤医院肾内科,贵州贵阳550003 [2]贵州医科大学临床医学院,贵州贵阳550004

出　　处：《中国血管外科杂志(电子版)》2024年第4期363-367,388,共6页Chinese Journal of Vascular Surgery(Electronic Version)

基　　金：贵州省卫生健康委科学技术基金项目(gzwkj2022-105);贵州省科技计划项目(黔科合成果-LC[2023]021)。

摘　　要：目的探讨血液透析患者颈内静脉带涤纶套隧道型血液透析导管(tunneled cuffed catheter,TCC)留置引发中心静脉病变的危险因素,为中心静脉病变的预防以及导管拔除时机提供依据。方法对贵州医科大学附属肿瘤医院肾内科2020年7月至2023年7月278例颈内静脉TCC拔管患者进行数字减影血管造影,回顾性观察患者中心静脉病变情况并分为中心静脉病变组及无中心静脉病变组,对两组患者一般资料、既往史和生化指标进行多因素Logistic回归分析,探讨TCC留置引发中心静脉病变的危险因素,再通过受试者工作特征(receiver operating characteristic,ROC)曲线分析导管留置时间对中心静脉病变的诊断价值,探讨最佳导管拔除时机。结果发生中心静脉病变患者228例(82.01%),其中单支病变189例,双支病变34例,三支及以上病变5例。多因素Logistic回归分析显示,导管留置时间[优势比(odds ratio,OR)=1.345,95%置信区间(confidence interval,CI)=1.013~1.787,P=0.040]、既往多次置管(OR=11.241,95%CI=1.418~89.082,P=0.022)、D-二聚体水平(OR=50444.235,95%CI=56.762~44829585.067,P=0.002)是颈内静脉TCC置入后发生中心静脉病变的独立危险因素。ROC曲线显示TCC拔管的最佳临界值为3个月,以此阈值监测中心静脉病变发生的敏感度为57.89%,特异性为98.72%。结论颈内静脉TCC置入后有较高的中心静脉病变发生率,与较长的导管留置时间、多次置管和高D-二聚体水平密切相关,建议导管留置时间不超过3个月。Objective To explore the risk factors for central venous disease after placement of tunneled cuffed catheter(TCC)in the internal jugular vein,and to provide a basis for the prevention of central venous disease and the timing of catheter removal.Methods Digital subtraction angiography was performed on 278 patients with internal jugular vein TCC removal from the Department of Nephrology,Cancer Hospital Affiliated to Guizhou Medical University from July 2020 to July 2023.The central venous disease of the patients were retrospectively observed and divided into a central venous disease group and a non-central venous disease group.Multivariate logistic regression analysis was performed on the general data,medical history and biochemical indicators of the two groups to explore the risk factors for central venous lesions caused by TCC placement.The receiver operating characteristic(ROC)curve was used to analyze the diagnostic value of TCC placement duration for central venous disease,and the optimal timing of catheter removal was explored.Results A total of 228 patients(82.01%)developed central venous disease,including 189 patients with single branch disease,34 patients with double branches disease,and 5 patients with three or more branches disease.Multivariate logistic regression analysis showed that catheter placement duration[odds ratio(OR)=1.345,95%confidence interval(CI)=1.013-1.787,P=0.040],multiple previous catheterizations(OR=11.241,95%CI=1.418-89.082,P=0.022)and D-dimer(OR=50444.235,95%CI=56.762-44829585.067,P=0.002)were independent factors associated with central venous disease after internal jugular vein TCC placement.The ROC curve showed that the optimal critical value for TCC removal was 3 months.The sensitivity of monitoring the occurrence of central venous disease at this threshold was 57.89%and the specificity was 98.72%.Conclusion The incidence of central venous lesions is high after TCC placement in the internal jugular vein,which is closely related to longer catheter indwelling duration,multiple cathet

关 键 词：血液透析导管 中心静脉 血液透析 

分 类 号：R47[医药卫生—护理学]