PermCath导管两种置管方法对比的前瞻性队列研究

目的 比较撕脱鞘导入法与直接导丝导入法留置Permcath导管的安全性及易用性. 方法 2009年9月至2011年12月入组2个透析中心拟行Permcath导管置管术的血液透析患者,按置管方法分为撕脱鞘导入组（简称撕脱鞘组）和直接导丝导入组（简称导丝组）,收集2组患者基线资料、置管前后血常规和凝血功能.置管后前瞻观察24h,主要终点为置管术中出血量,次要终点为整个置管术的操作时间和置管术后24h置管伤口出血事件发生率. 结果 撕脱鞘组共入组22例患者,导丝组共入组23例患者,2组基线资料基本一致.导丝组较撕脱鞘组在术中出血量（4.04±2.09ml比12.86±3.35ml,t=10.514,P=0.000）、置管时间（26.30±3.22min比34.36±2.98min,t=8.689,P=0.000）及术后24h出血事件发生率（4.358％比27.27％,x2=4.499,P=0.047）的差异均有统计学意义. 结论 直接导丝导入法比撕脱鞘导入法显著减少术中出血量、置管时间及术后24h出血事件发生率.

Comparison of the two insertion methods for Permcath catheter:a prospective cohort study

Objectives To compare the safety and usability of the two insertion methods,pull-apart sheath method and guide wire method,for the insertion surgery of indwelling Permcath dialysis catheter.Methods Two dialysis centers were involved in this study from September 2009 to December 2011.The patients who were arranged to use indwelling Permcath dialysis catheter were enrolled and divided into two groups,the use of pull-apart sheath method group(PAS group) and the use of guide wire group(WG group).Patients’ baseline information as well as the results of blood counts and blood coagulation tests were collected before and after the insertion surgery.Prospective observation was carried out since 24 hours after the insertion.The primary endpoint was the amount of blood loss during the insertion procedure;the secondary endpoints were the time spent for catheterization and the incidence of wound bleeding event within 24 hours after the insertion.Results There were 22 patients in the PAS group and 23 patients in the GW group.The baseline information was basically similar between the two groups.Compared with the PAS group,the GW group had significantly less blood loss during insertion procedure(4.04 ± 2.09ml vs 12.86 ± 3.35ml,P=0.000),shorter catheterization time(26.30 ± 3.22min vs 34.36 ± 2.98min,P=0.000),and lower incidence of wound bleeding event within 24 hours after the insertion(4.358% vs 27.27%,P=0.047).Conclusions The insertion of Permcath catheter by using guide wire can significantly reduced blood loss during insertion procedure,time spent for catheterization,and incidence of wound bleeding within 24 hours after the insertion,compared that by using pull-apart sheath method.