Sefer Sinisa, Kes Petar, Degoricija Vesna, Heinrich Branko, Vrsalović Mislav
KB Sestre milosrdnice, Zavod za nefrologiju i dijalizu, Vinogradska c. 29, 10 000 Zagreb.
Lijec Vjesn. 2003 Jan-Feb;125(1-2):1-5.
To measure percentage of urea recirculation in hemodialysis by a dual-lumen central venous catheters of various localisations (e.g. jugular, subclavian and femoral), and also in cases when the venous lumen of the catheter is used as arterial lumen, and vice versa, and under these conditions to evaluate the efficiency of hemodialysis based on the measurements of urea reduction ratio.
Percentage of urea recirculation was measured in the patients with acute and chronic renal failure who underwent hemodialysis by a temporary dual-lumen central venous catheter of different localisations (jugular n = 16, subclavian n = 20, femoral n = 20). The measurements were done in cases when arterial line was connected to arterial lumen of the catheter, and venous line to the venous lumen of the catheter (correct connection = RI), and vice versa, i.e., when arterial line was connected to venous lumen of the catheter, and venous line was connected to arterial lumen of the catheter (reversed connection = R2). The efficiency of hemodialysis was evaluated by measuring urea reduction ratio in cases with the reversed (R2) connection.
Statistically significant differences were found between R1 and R2 for jugular catheters (R1 = 2.38 +/- 1.09%, R2 = 7.59 +/- 1.42%, n = 16, p = 0), for subclavian catheters (R1 = 3.03 +/- 3.15%, R2 = 15.8 +/- 7.18, n = 20, p = 0), and for femoral catheters (R1 = 9 +/- 6.56%, R2 = 29.2 +/- 11.8%, n = 20, p = 0). Statistically significant differences were also found between R1 of jugular catheters and R1 of subclavian catheters (2.38 +/- 1.09%, n = 16 and 3.03 +/- 3.15%, n = 20, p = 0.0001), further on between R1 of jugular and R1 of femoral catheters (2.38 +/- 1.09%, n = 16 and 9 +/- 6.56%, n = 20, p = 0), as well as between R1 of subclavian and R1 of femoral catheters (2.38 +/- 1.09%, n = 20 and 9 +/- 6.56%, n = 20, p = 0.0001). Also statistically significant differences were found between R2 of jugular and subclavian catheters (7.59 +/- 1.42%, n = 16 and 15.8 +/- 7.18%, n = 20, p = 0.0003), between R2 of jugular and femoral catheters (7.59 +/- 1.42%, n = 16 and 29.2 +/- 11.8%, n = 20, p = 0.0007), and between R2 of subclavian and R2 of femoral catheters (15.8 +/- 7.18%, n = 20 and 29.2 +/- 11.8%, n = 20, p = 0.0029). The measurements of urea reduction ratio that we have done for some of the catheters under R2 conditions showed a statistically significant difference between femoral and subclavian catheters (51.45 +/- 5.62%, n = 20 and 63.75 +/- 7.61, n = 20, p = 0), and between femoral and jugular catheters (51.45 +/- 5.62%, n = 20 and 64.3 +/- 5.23%, n = 16, p = 0). No statistical differences were found in urea reduction ratio between jugular and subclavian catheters (64.3 +/- 5.23, n = 16 and 63.75 +/- 7.61%, n = 20, p = 0.8).
When hemodialysis is delivered by a correct blood lines connection the measurements have shown a decrease in urea recirculation by 5% for jugular and subclavian catheters, and 5%-10% for femoral catheters. However, in cases when the venous lumen of the catheter is used as an arterial lumen, and vice versa, urea recirculation is below 10% for jugular catheters; whereas in femoral catheters the percentage is higher than 20%. Despite so high percentage of urea recirculation, that we obtained for such use of the catheters, urea reduction ratio in hemodialysis via jugular and subclavian catheters is > 60%, whereas via femoral catheters, the percentage is significantly lower. Consequently, the efficiency of hemodialysis is reduced, and such use of femoral catheters should therefore be avoided.
通过不同部位（如颈内静脉、锁骨下静脉和股静脉）的双腔中心静脉导管测量血液透析中尿素再循环的百分比，以及当导管的静脉腔用作动脉腔、反之亦然的情况下，基于尿素清除率的测量评估血液透析的效率。
对接受不同部位（颈内静脉n = 16、锁骨下静脉n = 20、股静脉n = 20）临时双腔中心静脉导管血液透析的急性和慢性肾衰竭患者测量尿素再循环百分比。测量在动脉管路连接到导管的动脉腔、静脉管路连接到导管的静脉腔（正确连接 = RI）时进行，反之亦然，即动脉管路连接到导管的静脉腔、静脉管路连接到导管的动脉腔（反向连接 = R2）时进行。通过测量反向（R2）连接情况下的尿素清除率评估血液透析效率。
颈内静脉导管的R1和R2之间存在统计学显著差异（R1 = 2.38±1.09%，R2 = 7.59±1.42%，n = 16，p = 0），锁骨下静脉导管的R1和R2之间存在统计学显著差异（R1 = 3.03±3.15%，R2 = 15.8±7.18，n = 20，p = 0），股静脉导管的R1和R2之间存在统计学显著差异（R1 = 9±6.56%，R2 = 29.2±11.8%，n = 20，p = 0）。颈内静脉导管的R1与锁骨下静脉导管的R1之间也存在统计学显著差异（2.38±1.09%，n = 16和3.03±3.15%，n = 20，p = 0.0001），进而颈内静脉导管的R1与股静脉导管的R1之间存在统计学显著差异（2.38±1.09%，n = 16和9±6.56%，n = 20，p = 0），以及锁骨下静脉导管的R1与股静脉导管的R1之间存在统计学显著差异（2.38±1.09%，n = 20和9±6.56%，n = 20，p = 0.0001）。颈内静脉和锁骨下静脉导管的R2之间也存在统计学显著差异（7.59±1.42%，n = 16和15.8±7.18%，n = 20，p = 0.0003），颈内静脉和股静脉导管的R2之间存在统计学显著差异（7.59±1.42%，n = 16和29.2±11.8%，n = 20，p = 0.0007），以及锁骨下静脉和股静脉导管的R2之间存在统计学显著差异（15.8±7.18%，n = 20和29.2±11.8%，n = 20，p = 0.0029）。我们在R2条件下对一些导管进行的尿素清除率测量显示，股静脉和锁骨下静脉导管之间存在统计学显著差异（51.45±5.62%，n = 20和63.75±7.61，n = 20，p = 0），以及股静脉和颈内静脉导管之间存在统计学显著差异（51.45±5.62%，n = 20和64.3±5.23%，n = 16，p = 0）。颈内静脉和锁骨下静脉导管之间的尿素清除率无统计学差异（64.3±5.23，n = 16和63.75±7.61%，n = 20，p = 0.8）。
当通过正确的血液管路连接进行血液透析时，测量显示颈内静脉和锁骨下静脉导管的尿素再循环降低5%，股静脉导管降低5%-10%。然而，当导管的静脉腔用作动脉腔、反之亦然时，颈内静脉导管的尿素再循环低于10%；而股静脉导管的百分比高于20%。尽管我们通过这种导管使用获得了如此高的尿素再循环百分比，但通过颈内静脉和锁骨下静脉导管进行血液透析时的尿素清除率>60%，而通过股静脉导管时，该百分比显著更低。因此，血液透析效率降低，应避免如此使用股静脉导管。
