血液透析患者的带隧道导管：原因及后续结果。

Tunneled catheters in hemodialysis patients: reasons and subsequent outcomes.

作者信息

Lee Timmy, Barker Jill, Allon Michael

机构信息

Division of Nephrology, University of Alabama, Birmingham, AL, USA.

出版信息

Am J Kidney Dis. 2005 Sep;46(3):501-8. doi: 10.1053/j.ajkd.2005.05.024.

DOI:10.1053/j.ajkd.2005.05.024

PMID:16129212

Abstract

BACKGROUND

Reducing the use of tunneled catheters in hemodialysis patients requires concerted efforts to convert them to a usable permanent vascular access. The goal of this study is to evaluate the reasons for tunneled catheter use in our prevalent hemodialysis population and the success in converting them to a permanent vascular access.

METHODS

We identified all catheter-dependent hemodialysis patients at our center on a single date. These patients were followed up prospectively during a 1-year period to evaluate access procedures and conversion to permanent access use.

RESULTS

Of 458 prevalent hemodialysis patients, 108 patients (23.6%) were dialyzing through cuffed tunneled catheters: 18.5% had no further options for creation of a permanent vascular access, 28.7% had an immature access, 43.5% had access placement pending, and 9.2% had repeatedly refused access surgery. For 78 catheter-dependent patients (excluding patients with no access options and those who refused permanent access surgery), the likelihood of using a permanent access was 53% by 6 months and 80% by 1 year. In patients with an immature access, 50% were using a permanent access at 3 months, and 80%, at 6 months. Of patients with access surgery pending, 45% had access surgery performed within 3 months, and 70%, at 6 months. Finally, of all patients, the likelihood of catheter-related bacteremia was 48% at 6 months. On multivariable analysis, only duration of catheter dependence predicted subsequent use of a permanent access (hazard ratio, 3.11; 95% confidence interval, 1.70 to 5.68; P = 0.0002) for catheter dependence less than versus greater than 6 months.

CONCLUSION

Almost one quarter of our hemodialysis population is catheter dependent. Despite concerted efforts, there remain very long delays in achieving a usable permanent access, attributable to delays in both surgical access placement and access maturation. In the interim, this patient population developed a high frequency of catheter-related bacteremia.

摘要

背景

减少血液透析患者隧道式导管的使用需要共同努力，将其转换为可用的永久性血管通路。本研究的目的是评估在我们现有的血液透析人群中使用隧道式导管的原因，以及将其转换为永久性血管通路的成功率。

方法

我们在某一日期确定了我们中心所有依赖导管的血液透析患者。对这些患者进行为期1年的前瞻性随访，以评估血管通路手术及转换为永久性血管通路的使用情况。

结果

在458例现有的血液透析患者中，108例患者（23.6%）通过带 cuff 的隧道式导管进行透析：18.5%没有创建永久性血管通路的其他选择，28.7%的血管通路未成熟，43.5%的血管通路正在等待置入，9.2%的患者多次拒绝血管通路手术。对于78例依赖导管的患者（不包括没有血管通路选择的患者和拒绝永久性血管通路手术的患者），6个月时使用永久性血管通路的可能性为53%，1年时为80%。在血管通路未成熟的患者中，3个月时50%的患者使用永久性血管通路，6个月时为80%。在等待血管通路手术的患者中，45%的患者在3个月内进行了血管通路手术，6个月时为70%。最后，在所有患者中，6个月时导管相关菌血症的发生率为48%。多变量分析显示，对于导管依赖时间小于6个月与大于6个月的患者，只有导管依赖持续时间可预测随后对永久性血管通路的使用（风险比，3.11；95%置信区间，1.70至5.68；P = 0.0002）。