中国血液净化

中国血液净化 ›› 2016, Vol. 15 ›› Issue (10): 522-526.doi: 10.3969/j.issn.1671-4091.2016.10.003

• 临床研究 • 上一篇    下一篇

开腹式腹膜透析管置入术后非感染性并发症的相关危险因素分析——单中心14年经验分享

王梦婷,马亚琪,田娜,王艳,马小琴,张红霞,王永春,赵彩萍,陈孟华   

  1. 宁夏医科大学总医院肾脏内科(王梦婷、马亚琪，为并列第一作者)
  • 收稿日期:2016-04-13 修回日期:2016-07-22 出版日期:2016-10-12 发布日期:2016-10-10
  • 通讯作者: 陈孟华，田娜 nxchenmh@163.com,snowwife@163.com E-mail:nxchenmh@163.com
  • 基金资助:

    宁夏医科大学特殊人才启动项目(项目编号：XT2015020)

Risk factors for peritoneal non-infection complications in patients with open surgery for catheter implantation: the experience of 14 years in a single center

  • Received:2016-04-13 Revised:2016-07-22 Online:2016-10-12 Published:2016-10-10

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摘要： 目的探讨腹膜透析导管置入术后非感染性并发症的发生情况及相关危险因素，旨在探寻预防非感染性并发症的方法。方法回顾性纳入2002 年1 月1 日～2016 年1 月31 日采取开腹式腹膜透析管置入术的患者。收集患者的人口学资料、临床实验室指标、置管情况、返院随访频次、置管后非感染并发症的发生、处理及转归情况等临床资料。比较并发症组与非并发症组的临床特征，分析并发症相关的危险因素。结果①共纳入677 例，平均年龄(51.03±12.77)岁，中位透析龄22(7.00, 45.00)月。②非感染并发症发生情况：共发生各种非感染并发症125(18.46%)例，其中导管漂移发生率最高，共79 例，发生率为11.66%，其次为导管堵塞、疝气、胸腹瘘、透析液渗漏，发生率分别为：5.47%、0.74%、0.29%、0.29%。上述并发症中109(87.20%)例经保守治疗后缓解，10(8.69%)例重新置管后继续腹膜透析，6(5.22% )例转为血液透析；③与非并发症组相比，发生并发症组的患者透析龄较短(Z=- 14.725, P＜0.001)，返院随访频次较少(χ2=7.820，P =0.020)，有经验的置管医生置管后出现并发症较少(χ2=9.291, P=0.010)。④多因素Cox 回归分析结果显示校正混杂因素后年龄越大(HR 1.015,95% CI 1.001～1.030, P= 0.038)、返院随访频次越低(HR 1.147,95% CI 1.010～1.303，P=0.034)、以及置管医生经验不足(HR 1.328,95% CI 1.096～1.609，P =0.004)是腹膜透析导管置入术后发生非感染并发症的独立危险因素。结论腹膜透析管置入术后非感染性并发症以导管漂移、导管堵塞最为常见，大多数经过保守处理可以解除。高龄、置管医生的技术问题、返院随访频次少是腹膜透析导管置入术后发生非感染性并发症的独立危险因素。

关键词: 腹膜透析, 非感染并发症, 危险因素, 导管漂移, 导管堵塞

Abstract: Objective To explore the peritoneal non-infection complications in patients with open surgery for catheter implantation and its risk factors. Methods This was a retrospective cohort study. Patients with open surgery for implantation of peritoneal dialysis catheter in our hospital from Jan. 1, 2002 to Jan. 31, 2016 were enrolled in this study. Demographic data, clinical laboratory parameters, catheters, follow-up frequency, non-infection complications due to catheters, treatment, and outcome were collected. Clinical features and the risk factors for the complications were compared between the patients with and without the complications.
Results ①A total of 677 patients were included. The average age was 51.03±12.77 years and the median dialysis vintage was 22 (7.00, 45.00) months. ② Non- infection complications were identified in 125 (18.46%) cases. The most common complication was catheter migration (79 cases, 11.66%), followed by obstruction in catheter, hernia (5.47%), thoracoabdominal fistula (0.74%), and dialysate leakage (0.29%). Regarding outcome of the complications, 109 (87.20% ) patients were cured by conservative treatment, 10 (8.69%) were re-implanted with the catheter, and 6 (5.22%) were transferred to hemodialysis. ③Compared with non-complication group, the patients with complications had a shorter vintage (Z=-14.725, P＜0.001), less follow-up frequency (χ2=7.820, P=0.020), and the operation by less experienced doctors (χ2=9.291, P=0.010). ④Multivariate Cox regression analysis showed that advanced age (HR 1.015, 95% CI 1.01～1.030, P=0.038), less follow-up frequency (HR 1.147, 95% CI 1.010～1.303, P=0.034), and operation by less experienced doctor (HR 1.328, 95% CI 1.096～1.609, P=0.004) were the independent risk factors for non-infectioncomplications after adjustment for confounders. Conclusion The most common non-infection complications were catheter migration and catheter blockage in peritoneal dialysis patients. Most of the patients could be cured by conservative treatment. Advanced age, less follow-up frequency, and operation by less experienced doctors were the independent risk factors for the noninfection complications.

Key words: Peritoneal dialysis, Non-infection complications, Risk factors, open surgery catheter implantation, catheter blockage