Wang Lihua, Wei Fang, Jiang Aili, Chen Haiyan, Sun Guijiang, Bi Xueqing
Department of Kidney Disease and Blood Purification Center, Institute of Urology and Key Laboratory of Tianjin, 2nd Affiliated Hospital of Tianjin Medical University, 23rd, Pingjiang Road, Hexi District, Tianjin, 300211, People's Republic of China.
Int Urol Nephrol. 2015 Oct;47(10):1727-34. doi: 10.1007/s11255-015-1089-7. Epub 2015 Sep 2.
Although tunneled cuffed catheters (TCCs) are widely used in hemodialysis, little is known about their complications in elderly patients with hemodialysis. Furthermore, there is no report about which vessel access, either jugular or iliac vein, is superior for elderly patients requiring TCCs.
In the present study, we reviewed the clinical parameters of 127 patients aged over 65 years with 207 new TCC placements and measured the incidence of catheter patency, infection, dysfunction, and survival of TCCs.
We found that the average primary catheter patency was substantially shorter in iliac vein TCCs than in internal jugular vein TCCs (373 vs. 641 catheter-days). Patients with iliac vein TCCs underwent more frequent exchanges than those with internal jugular vein TCCs. Infection-free survival was similar for both groups (p = 0.748), but dysfunction-free survival was significantly poorer in iliac vein TCC group than that in internal jugular vein TCC group (p = 0.001). Age and previous catheter placement were the independent risk factors for TCCs survival.
Taken together, our results suggested that iliac vein TCCs present an increased risk of dysfunction compared to internal jugular vein TCCs in elderly hemodialysis patients.
尽管带隧道带涤纶套导管(TCCs)在血液透析中广泛应用,但对于老年血液透析患者使用该导管的并发症却知之甚少。此外,对于需要TCCs的老年患者,哪种血管通路(颈静脉或髂静脉)更具优势尚无相关报道。
在本研究中,我们回顾了127例65岁以上接受207次新TCC置入的患者的临床参数,并测量了导管通畅率、感染率、功能障碍发生率以及TCCs的生存率。
我们发现,髂静脉TCCs的平均初次导管通畅时间显著短于颈内静脉TCCs(分别为373天和641天导管日)。与颈内静脉TCCs患者相比,髂静脉TCCs患者更换导管更为频繁。两组的无感染生存率相似(p = 0.748),但髂静脉TCC组的无功能障碍生存率显著低于颈内静脉TCC组(p = 0.001)。年龄和既往导管置入史是TCCs生存的独立危险因素。
综上所述,我们的结果表明,在老年血液透析患者中,与颈内静脉TCCs相比,髂静脉TCCs发生功能障碍的风险增加。