连续性肾脏替代治疗患者的血管通路

摘要

目的:了解连续性肾脏替代治疗(CRRT)患者血管通路使用及并发症情况. 方法:收集2014年4月～2014年10月南京总医院行连续性肾脏替代治疗患者的资料,包括患者血管通路使用情况及实验室检查结果等. 结果:共入选292例患者,其中男性175例(59.9％)、女性117例(40.1％),平均年龄50.8±18.6岁.CRRT患者以急性肾损伤、多器官功能障碍综合征及全身炎症反应综合征患者为主.血管通路:280例患者为无涤纶套导管,所占比例为95.9％,置管部位主要为右侧颈内静脉(54.3％).32例患者(11.4％),在CRRT治疗过程中需要重新置管.导管功能失功占全部患者的7.14％,导管功能失功的中位时间5d,多因素分析表明CRRT累计时间和血红蛋白水平是导管功能失功的主要风险因素.此外,导管感染发生的平均时间为置管后10.7d,导管感染发生率7.19/1000导管日.影响导管感染的主要因素是导管累计使用时间和血清白蛋白(Alb)水平. 结论:通过横断面调查发现CRRT治疗患者血管通路主要为无涤纶套导管,置管部位以右侧颈内静脉为主,部分患者需要重新置管.CRRT累计时间、Hb和Alb水平分别是导管功能失功和导管感染的主要风险因素.%Objective:To analyze the character of vascular access and its complications in patients receiving continuous renal replacement therapy (CRRT).Methodology:The patients who treated with CRRT from April 2014 to Septemper 2014 in our hospital were included in this study.Demographic data was collected and laboratory test results were conducted.The data of vascular access were obtained from our database.Results:A total of 292 patients was enrolled in the study.Patients who needed CRRT were mainly caused by AKI,MODS and SIRS.Initial vascular access was non-cuffed temporary catheters in 280 patients and it was preferentially obtained in the right internal jugular vein (54.3％).There were 32 (11.4％) patients needed re-catheterization.Catheter malfunction accounted for 7.14％ of all patients,and the median time of catheter malfunction was found at the 5th day.By multivariate analysis,it was found that the main risk factors of catheter malfunction were cumulative treatment time of CRRT and the level of hemoglobin.The average time of catheterrelated infections was 10.7 days after insertion and the catheter-related infections were 7.19 per 1000 catheter days.The main risk factors of catheter-related infections were cumulative time of catheterization and the level of serum albumin.Conclusion:In the present cross-sectional study,the initial vascular access was non-cuffed temporary catheter in CRRT patients,and the first inserted site was the right internal jugular vein.Some patients needed re-catheterization during CRRT.The main risk factors of catheter malfunction were cumulative time of CRRT and the level of hemoglobin.In addition,the main risk factors of catheter-related infections were cumulative time of catheterization and the level of serum albumin.