中国血液净化

中国血液净化 ›› 2012, Vol. 11 ›› Issue (2): 73-76.doi: 10.3969/j.issn.1671-4091.2012.02.00

• 临床研究 • 上一篇    下一篇

新型长期血液透析导管Palindrome的临床应用

李明旭,张志勇,余永武,陈洪,李欣欣,李洪艳,马军红,董珍,周春华   

  1. 海军总医院肾脏病科
  • 收稿日期:2011-08-07 修回日期:1900-01-01 出版日期:2012-02-12 发布日期:2012-02-12
  • 通讯作者: 李明旭

Clinical use of the new type long-term cuffed Palindrome catheter in hemodialysis patients

LI Ming-xu, ZHANG Zhi-yong, YU Yong-wu, CHEN Hong, LI Xin-xin, LI Hong-yan, MA Jun-hong, DONG Zhen, ZHOU Chun-hua.   

  • Received:2011-08-07 Revised:1900-01-01 Online:2012-02-12 Published:2012-02-12

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摘要： 【摘要】 目的 比较新型长期透析导管Palindrome同以往长期透析导管Permcath及动静脉内瘘为血管通路的血液透析患者在透析充分性、导管功能及并发症方面的异同。方法 以使用Permcath导管临床资料完整43例为Permcath组，Palindrome导管49例为Palindrome组，同期动静脉内瘘56例为AVF组。观察各组尿素清除率(Kt/V)、尿素下降率(URR)，导管最大血流量，各组导管相关感染、血栓发生及导管1年通畅率等。结果 选择长期透析导管占同期透析通路比例为49.2%，首次直接选择长期透析导管比例为17.4%。使用长期透析导管患者病因中，继发性肾损害(代谢性疾病、高血压、缺血性肾病等)占73.1%，明显高于AVF组的51.5%(t=13.064,P=0.000,)。Palindrome组在Kt/V、URR、1年通畅率上明显优于Permcath组(P分别=0.02,0.007,0.021），与AVF组无显著差异。Palindrome组通路相关感染发生率明显高于AVF组(2=4.5946，P=0.032)，血栓发生率为30.6%，明显低于Permcath组的48.8%(2=7.8125，P=0.005)，高于AVF组的5.4%(2=5.9019，P=0.015)。结论 Palindrome导管在最大血流量，透析充分性、1年通畅率等方面优于Permcath导管，与AVF患者相当，但仍有较高的感染率和血栓发生率。长期透析导管只能作为维持性透析患者血管通路的较好补充形式，不作为首选。

Abstract: 【Abstract】 Objective To compared dialysis adequacy, catheter function and complications among hemodialysis patients using the new type long-term dialysis catheter of Palindrome, those using permcath long-term dialysis catheter, and those using arteriovenous fistulas as the vascular access. Methods A total of 43 cases using Permcath long-term dialysis catheter with complete clinical data was assigned as Permcath group, 49 cases using Palindrome catheter with complete clinical data as Palindrome group, and 56 cases using arteriovenous fistula (AVF) with complete clinical data as AVF group. Their urea clearance (Kt/V), urea reduction rate (URR), the largest blood flow, catheter-related infection, catheter thrombosis formation, and the patency rate in a year were observed.  Results The maximum blood flow velocity was significantly higher in Palindrome group than in Permcath group. The rate of patients using long-term dialysis catheters as blood access was finally 49.2%, but was only 17.4% at the earlier dialysis course. Secondary kidney damages (metabolic disease, hypertension, ischemic nephropathy, etc.) accounted for 73.1% patients to use long-term dialysis catheters, and only 51.5% patients to use AVF (t= 13.064, P=0.000). Kt/V, URR and the catheter patency rate in a year were better in Palindrome group than in Permcath group (P=0.02, 0.007, 0.021, respectively), but were similar between Palindrome group and AVF group. Blood access related infection was higher in Palindrome group than in AVF group (χ2=4.5946, P=0.032). The prevalence of thrombosis was 30.6% in Palindrome group, lower than that in Permcath group (48.8%, χ2=7.8125, P=0.005), and higher than that in AVF group (5.4%, χ2=5.9019, P=0.015).  Conclusion The effects of long-term Palindrome dialysis catheter on maximum blood flow, dialysis adequacy and one year patency rate were superior to Permcath catheter, and were similar to AVF. However, Palindrome catheter had higher prevalence of infection and thrombosis. Therefore, long-term Palindrome dialysis catheter can be used as the better complement but not the best approach for blood access in patients on maintenance hemodialysis.

Key words: Long-term dialysis catheter, ,Palindrome,Arteriovenous fistula,Dialysis adequacy,Complication