Gurudev K C, Ramkumar T S, Pathak V, Prabhakar K S, Bhaskar S, Prakash K C, Mani M K
Department of Nephrology, Apollo Hospitals, Madras.
J Assoc Physicians India. 1992 Jun;40(6):370-3.
We have retrospectively analysed the usefulness of a subcutaneous tunnel in patients undergoing haemodialysis through a double lumen subclavian catheter; 194 catheters were used in 145 patients. In 105 patients a subcutaneous tunnel was created. Entry site infection was significantly higher in the no tunnel group (30%; P < 0.02). There was no statistically significant difference in the incidence of septicaemia in the two groups. Eighty five percent of episodes of septicaemia and 67% of entry site infections were due to Staphylococcus aureus. All responded to removal of the catheter and to antibiotics. The average duration the catheter was in place was 20.39 and 21.94 days in the groups with and without tunnel respectively. The average number of dialyses was 9.13 and 9.33 per catheter in the tunnel and no tunnel groups respectively. Three patients had pneumothorax. Subclavian vein thrombosis was suspected clinically in 3 cases. There was no catheter related mortality. We concluded that while entry site infection occurred more frequently in the no tunnel group, the overall incidence of septicaemia was not different in the two groups. Creation of a subcutaneous tunnel has no added advantage.
我们回顾性分析了皮下隧道在经锁骨下双腔导管进行血液透析患者中的作用；145例患者共使用了194根导管。105例患者创建了皮下隧道。无隧道组的入口部位感染率显著更高（30%；P<0.02）。两组败血症的发生率无统计学显著差异。85%的败血症发作和67%的入口部位感染由金黄色葡萄球菌引起。所有病例通过拔除导管和使用抗生素后均有反应。有隧道组和无隧道组导管的平均留置时间分别为20.39天和21.94天。隧道组和无隧道组每根导管的平均透析次数分别为9.13次和9.33次。3例患者发生气胸。临床怀疑3例发生锁骨下静脉血栓形成。无导管相关死亡。我们得出结论，虽然无隧道组入口部位感染更频繁发生，但两组败血症的总体发生率并无差异。创建皮下隧道并无额外优势。
