不同类型腹膜透析导管临床应用体会

目的观察不同类型腹膜透析导管的近期并发症的发生率情况及防治体会。方法68例终末期肾衰竭行维持性腹膜透析治疗患者分为两组。组1：28例患者采用Tenckhoff曲管;组2：40例患者采用鹅颈直管。两组患者随访时间均大于6个月。观察两组患者的腹膜透析液引流速度、隧道感染、出口感染、导管移位、腹膜透析液渗漏等发生情况。结果两组患者腹膜透析液引流速度的隧道感染率和出口感染率无差别（P〉0.05）.Tenckhoff管组5例患者出现导管移位（17.8%）,而swan-neck导管组仅2例（5%）,两组相比有显著性差异（P〈0.05）。进一步分析发现前组患者漂管发生于第一周3例（60%）,第二周2例（40%）,而鹅颈直管发生漂管多于1周内。另外鹅颈直管组有3例患者于术后第一周出现引流不畅,拔管时发现导管内均有大量蛋白凝块阻塞。结论不同类型导管各有优缺点,鹅颈直管的导管移位率明显低于Tenckhoff导管,但易发生透析液引流不畅,而Tenckhoff导管不容易发生堵管。在置管过程中调整swan-neck腹膜透析管外段与腹正中线的角度后能明显改观引流速度。改观

Clinical experiences in peritoneal dialysis using different types of catheters

Objective To investigate the clinical indication and complication of peritoneal dialysis using different types of dialysis catheters.Methods Sixty-eight patients with end stage renal disease on peritoneal dialysis were divided into two groups.Twenty-eight patients used Tenckhoff-coil catheter were assigned in group 1,and 40 patients used swan-neck straight type catheter were in group 2.They were followed up for more than 6 months.Their in/out flow rate of dialysate,infection at tunnel and exit-site,catheter dislocation and dialysate leakage were observed.Results There were no differences in flow rate of dialysate drainage and infection rate at tunnel and exit-site between group 1 and group 2（P 〉0.05）.Tenckhoff-coil catheter was often replaced by swan-neck straight type catheter due to the higher dislocation rate associated with the former catheter（17.8% vs.5%）.Conclusion Catheter dislocation rate was lower in patients using swan-neck straight type catheter than in those using Tenckhoff-coil catheter.However,swan-neck straight type catheter was often associated with inadequate drainage or blockage.The drainage efficiency of swan-neck straight type catheter can be significantly improved after adjustment of the angle between outer seg-ment of the tube and abdomen median line during insertion of the catheter.