带隧道和涤纶套透析导管拔管方式的探讨  

Exploration of the method to remove tunnel-cuffed catheter

作　　者：刘海燕 耿兴花 任雯雯 赵娜新 向攀 LIU Hai-yan;GENG Xing-hua;REN Wenwen;ZHAO Na-xin;XIANG Pan(Department of Nephrology,Beijing Ditan Hospital,Capital Medical University,Beijing 100015,China)

机构地区：[1]首都医科大学附属北京地坛医院肾内科,北京100015

出　　处：《中国血液净化》2025年第4期313-316,共4页Chinese Journal of Blood Purification

摘　　要：目的观察无切口方式对于血液透析患者带隧道和涤纶套透析导管(tunnel-cuff catheter,TCC)拔除术的效果、并发症、患者耐受度,以寻找更适合患者的拔管方式。方法选择2021年3月─2024年7月首都医科大学附属北京地坛医院肾内科血液净化中心常规血液透析患者,应用无切口方式(直接隧道口钝性分离)拔除带隧道和涤纶套透析导管患者19例作为试验组,应用传统经典方式切开后分离cuff方式拔除20例作为对照组,获取相关基线资料。结果试验组患者19例,对照组患者20例。试验组患者平均手术时间(χ^(2)=7.014,P<0.001)、手术中出血量(χ^(2)=9.160,P<0.001)、盐酸利多卡因用量(χ^(2)=4.867,P<0.001)、患者耐受度疼痛评分(χ^(2)=7.341,P<0.001)均低于对照组。2组患者在导管留置时间(χ^(2)=0.729,P=0.470)、导管拔除原因(t=0.174,P=0.676)、渗血和/或血肿发生(t=1.004,P=0.316)间比较差异无统计学意义。结论无切口法拔除带隧道和涤纶套透析导管可以缩短手术时间、降低出血量、减少血肿发生率,重点是可以显著降低患者疼痛度,耐受度增加,此法安全有效。Objective To observe the effect,complication and patient’s tolerance to remove tunnelcuffed catheter without incision,in order to find out a catheter withdrawal method more suitable for hemodialysis patients.Method A total of 19 patients undergoing routine hemodialysis from March 2021 to July 2024 at the Blood Purification Center,Department of Nephrology,Beijing Ditan Hospital affiliated to Capital Medical University were recruited as the experimental group.They were treated with non-invasive method to remove the tunnel-cuffed catheter(direct and blunt separation at the tunnel opening).A total of 20 patients were recruited as the control group;their tunnel-cuffed catheters were removed by traditional cuff separation after incision.Patients’baseline data were collected.Result There were 19 patients in the experimental group,with an average surgical time of 7.95±1.00 minutes,intraoperative blood loss of 1.74±0.17ml,lidocaine hydrochloride dosage of 2.79±0.21ml,and pain tolerance score of 1.96±0.32 points.There were 20 patients in the control group,with an average surgical time of 27.00±2.29 minutes,intraoperative blood loss of 5.05±0.32ml,lidocaine hydrochloride dosage of 5.15±0.44ml,and tolerance pain score of 5.40±0.34.All of the indicators were statistically better in experimental group than in control group(average surgical time:χ^(2)=7.014,P<0.001;intraoperative bleeding:χ^(2)=9.160,P<0.001;lidocaine hydrochloride dosage:χ^(2)=4.867,P<0.001;tolerance pain score:χ^(2)=7.341,P<0.001).There were no statistical differences in age,gender,dialysis age,catheter indwelling time,reason for catheter removal,occurrence of bleeding and/or hematoma,and postoperative infection between the two groups(age:χ^(2)=0.147,P=0.884;gender:t=0.445,P=0.946;dialysis age:χ^(2)=0.766,P=4.48;catheter indwelling time:χ^(2)=0.729,P=0.470;reason for catheter removal:t=0.174,P=0.676;occurrence of bleeding and/or hematoma:t=1.004,P=3.16).Conclusion The non-incision method to remove tunnel-cuffed catheters can shorten the ope

关 键 词：带隧道和涤纶套导管 血液透析 尿毒症 无切口拔管技术 患者耐受度 手术后并发症 

分 类 号：R459.5[医药卫生—治疗学]