Fry Andrew C, Stratton Jon, Farrington Ken, Mahna Kapil, Selvakumar Sadasivam, Thompson Hilary, Warwicker Paul
Lister Renal Unit, Lister Hospital, Stevenage, Hertfordshire, England.
Nephrol Dial Transplant. 2008 Jan;23(1):275-81. doi: 10.1093/ndt/gfm582. Epub 2007 Sep 21.
In 2001, in the US, 23% of haemodialysis patients were dialysing through tunnelled venous catheters (TVCs), and in the UK (2006) there were 28% of prevalent patients using catheters. It is unlikely that numbers will significantly decrease. We present the results of a prospective audit of the survival of 812 TVCs placed in 492 patients at our institution over a 6-year period (comprising 212 048 patient catheter days or 7068 patient catheter months of follow-up). Four different designs of catheter were studied: Split-Cath III (Medcomp), HemoSplit (Bard), Tesio twin catheter (Medcomp) and Permcath (Quinton).
We used Kaplan-Meier survival analysis with log-rank test, to compare the effect of different parameters on catheter survival. The relative importance of significant parameters was determined by Cox regression analysis.
We have shown a significant catheter survival advantage of first catheters over second and subsequent insertions, of right internal jugular site over left internal jugular and thereafter over femoral site, and of non-diabetic over diabetic patients. Patient age, sex and operator (physician in ward-based procedure room under ultrasound control or surgeon in operating theatre under fluoroscopic assistance) did not significantly affect survival. The Permcath design demonstrated inferior survival in all but first catheter insertions in catheter-naïve patients. The HemoSplit and Tesio twin catheter designs demonstrated best survival overall. By Cox proportional hazard modelling the design and the position of the TVC seemed to be the most significant independent survival factors.
Clinicians need accurate data regarding catheter survival, mode of insertion and design, to inform practice.
2001年在美国，23%的血液透析患者通过带隧道的静脉导管（TVC）进行透析，而在英国（2006年），有28%的现存患者使用导管。这些数字不太可能显著下降。我们展示了对我院492例患者在6年期间置入的812根TVC的生存情况进行前瞻性审计的结果（包括212048个患者导管日或7068个患者导管月的随访）。研究了四种不同设计的导管：Split-Cath III（Medcomp公司）、HemoSplit（巴德公司）、特西奥双腔导管（Medcomp公司）和Permcath（昆顿公司）。
我们使用Kaplan-Meier生存分析和对数秩检验，比较不同参数对导管生存的影响。通过Cox回归分析确定显著参数的相对重要性。
我们已表明，首次置入的导管相比第二次及后续置入的导管、右侧颈内静脉部位相比左侧颈内静脉部位以及之后相比股静脉部位，以及非糖尿病患者相比糖尿病患者，导管生存具有显著优势。患者年龄、性别和操作者（超声引导下病房操作室的医生或透视辅助下手术室的外科医生）对生存没有显著影响。Permcath设计在初置导管患者中除首次导管置入外的所有情况中显示出较差的生存率。HemoSplit和特西奥双腔导管设计总体上显示出最佳生存率。通过Cox比例风险模型分析，TVC的设计和位置似乎是最显著的独立生存因素。
临床医生需要关于导管生存、置入方式和设计的准确数据，以指导实践。
