经皮下隧道留置的带涤纶套血液透析用长期导管使用的影响因素分析

目的 前瞻性分析了既往5年内南京解放军第八一医院32例次经皮下隧道留置的带涤纶套血液透析用长期导管的使用寿命情况.有2种不同设计的导管参与了研究：HemoSpl it （Bard）,Permcath（Quinton）.方法 我们使用Kaplan-Meier单因素分析来比较不同因素对导管寿命的影响,利用Cox多元回归分析比较各影响因素的相对重要性. 结果 我们发现在导管的使用寿命方面,是否首次置管对导管总体使用寿命无显著影响（P=0.897）;置管途径中以右颈内静脉留置导管最佳（中位生存时间1101天）;非糖尿病患者导管使用时限较糖尿病患者长（中位生存时间分别是1126天及898天,P=0.024）;HemoSplit导管优于Permcath导管（中位生存时间分别是1126天及825天,P=0.126）.患者的年龄、性别对导管使用影响不大.Cox比例风险模型发现糖尿病及导管所在静脉的选择均为导管留置寿命的独立影响因素. 结论 临床医生在操作前应准确掌握可能影响导管使用寿命的因素并充分考虑到原发病和导管的置入途径.

Factors affecting long-term survival of tunneled cuffed hemodialysis catheters

Objective To evaluate the factors affecting long-term survival of tunneled cuffed venous catheters （TVCs） in hemodialysis patients.Two different catheters,HemoSplit （Bard） and Permcath （Quinton）were used in this study.Methords Kaplan-Meier survival analysis with log-rank test was used to compare the effect of various factors on catheter survival.Cox regression analysis was performed to determine the relative importance of various factors.Results First,second or subsequent catheterizations had no effect on catheter survival.Age and sex also did not significantly affect catheter survival.Catheter survival was longer in right internal jugular vein indwelling catheterization and non-diabetic patients.HemoSplit catheter was better than Permcath catheter in catheter survival.Cox proportional hazard modelling demonstrated that diabetes and the vein the catheter indwells in were the independent factors for catheter survival.Conclusion Primary diseases and the vein for catheterization significantly affect catheter survival.These factors should be considered before the surgery.