带涤纶套中心静脉导管在糖尿病肾病血液透析患者中的失功率及影响因素研究

目的探讨带涤纶套中心静脉导管在糖尿病肾病血透患者中的失功率及其影响因素。方法 34例糖尿病肾病行右侧颈内静脉留置带涤纶套长期导管患者,根据置管后是否出现导管功能不良(连续3次血流量低于200 ml/min,需要调整体位、反接透析管路,甚至溶栓治疗等干预措施),将其分成失功组和非失功组;记录两组患者的年龄、性别、带管透析龄、糖尿病病程、体质指数(BMI),血红蛋白(Hb)、血细胞比容(Hct)、血小板(Plt)、血清总胆固醇(TC)、三酰甘油(TG)、清蛋白(Alb)、空腹血糖(FBG)、糖化血红蛋白(HbA1c)、超敏C反应蛋白(hs-CRP)、活化部分凝血活酶时间(APTT)、D-二聚体(D-D)等实验室指标;记录临时导管留置时间(TCT)、长期导管外接头位置(CCP)、长期导管种类(LCT)、肝素封管浓度(HC),尿素清除指数(Kt/V)、透析相关低血压(IDH)发生率、口服抗凝药物情况(OAD);比较两组之间的差别,并从中找出影响长期导管失功的相关因素。结果入选患者34例,出现导管功能不良(失功)15例,长期导管失功率为44.1%,出现时间为16～752 d。导管障碍率为1.37例次/1 000导管日。失功组的hs-CRP、TCT明显高于非失功组,而外接动脉接头在导管内侧者的比例和采用纯肝素封管者的比例明显低于非失功组,差异均有统计学意义(P<0.05);二分类Logistic回归分析显示,hs-CRP升高是长期导管失功的独立危险因素。两组患者的年龄、男女构成、带管透析龄、糖尿病病程、BMI、Hb、Hct、Plt、TC、TG、Alb、FBG、HbA1c、APTT、D-D,LCT、Kt/V、OAD、IDH发生率比较差异均无统计学意义(P>0.05)。结论带涤纶套中心静脉导管在糖尿病肾病患者中有较高的失功率;临时透析管的留置时间、动脉外接头位置、肝素导管封管浓度等因素均可影响导管功能,hs-CRP升高是长期导管失功的独立危险因素。

Dysfunction of Long-term Cuffed Indwelling Central Venous Catheterization during Hemodialysis of Patients with Diabetic Nephropathy:Its Incidence and Relevant Factors

Objective To investigate the dysfunction rate of long-term cuffed central venous catheter during hemodialysis of patients with diabetic nephropathy and its related factors.Methods The cuffed central venous catheter was indwelled in right internal jugular vein of 34 patients,who were further divided into two groups based on the functioning of these catheters:dysfunction group and non-dysfunction.The dysfunction was defined by:blood flow(BF) <200 ml/min for three times continuously and requireed interventions including body position adjustment,inversion of tube connection during hemodialysis,and thrombolysis therapy.The age,gender,age of catheter dialysis,history of diabetes,body mass index(BMI),hemoglobin(Hb),hematocrit(Hct),platelet(Plt),total cholesterol(TC),triglyceride(TG),albumin(Alb),fasting blood(FBG),HbA1c,high sensitive C-reactive protein(hs-CRP),activated partial thromboplastin time(APTT),D-dimers(D-D),temporary catheter time(TCT),catheter out-connector position(CCP),type of long-time catheter(LCT),heparin concentration of catheter sealing(HC),Kt/V,intradialic hypotension(IDH),and oral anticoagulants drug therapy(OAD) were measured or recorded.The continuous variables were compared using t test,and the classification variables were compared using Chi square test.Results Fifteen(44.1%) of these 34 cases experienced catheter dysfunction 16~752 days after the operation.The obstacle rate was 1.37 cases /1000 catheter days.The two groups showed no significant differences in age,gender,catheter dialysis ages,duration of diabetes,BMI,Hb,Hct,Plt,TC,TG,Alb,FBG,HbA1c,APTT,D-D,LCT,Kt/V,IDH and OAD.The dysfunction group had significantly higher hs-CRP and TCT and lower percentages of external artery catheter inside and pure heparin sealing catheter.Logistic aggression analysis indicated that elevated hs-CRP was an independent risk factor for long-time catheter dysfunction.Conclusion During hemodialysis,long-term cuffed central venous catheter had a higher dysfunction rate in patients with diabetic nephropathy than the general population.The indwelling time of temporary central venous catheter,position of external artery catheter,and heparin concentration of sealing catheter may be the relevant factors.Elevated hs-CRP is an independent risk factor for the dysfunction of long-time cuffed indwelling catheters.