背景:右颈内静脉是隧道血液透析导管放置的首选方法。然而,插入部位对导管长期结局的影响仍不确定.
目的:我们旨在分析大量的隧道血液透析导管放置情况,以根据中心静脉导管位置比较短期和长期结果。
方法:对两个中心连续插入隧道导管进行了7年的回顾性队列研究。主要结果是导管存活率,根据中央静脉部位进行比较。我们使用Kaplan-Meier曲线法和Cox比例风险模型来确定导管插入路径对主要通畅性的影响。针对导管失败的临床风险因素进行了调整。
结果:在620例患者中,有967个隧道透析导管放置。右颈内静脉导管的中位生存期为569天。右颈内静脉导管失败率无差异,左颈内静脉(调整后的危险比[HR],0.80;95%置信区间[CI],0.52-1.21),颈外(HR,0.79;CI,0.33-3.13),锁骨下(HR,0.67;CI,0.58-2.44)和股静脉(HR,1.20;CI,0.36-1.33)多变量分析后的导管。两组之间在功能或并发症方面没有重大差异。
结论:本研究发现,隧道血液透析导管插入部位与导管存活之间无统计学意义的关系。当前的透析血管通路方法应针对特定患者情况进行调整。
BACKGROUND: The right internal jugular vein is the preferred approach to tunnelled haemodialysis catheter placement. However, the effect of the insertion site on long-term catheter outcomes remains uncertain.
OBJECTIVE: We aimed to analyse a large cohort of tunnelled haemodialysis catheter placements to compare short-term and long-term results according to central venous catheter location.
METHODS: A retrospective cohort
study was performed on consecutive tunnelled catheter insertions at two centres over 7 years. The primary outcome was catheter survival, compared according to the central vein site. We used the Kaplan-Meier curve method and Cox proportional hazards modelling to determine the effect of the catheterisation route on primary patency, adjusted for clinical risk factors for catheter failure.
RESULTS: There were 967 tunnelled dialysis catheter placements in 620 patients. The median survival for right internal jugular vein catheters was 569 days. There were no differences in rates of catheter failure between right internal jugular, left internal jugular (adjusted hazard ratio [HR], 0.80; 95% confidence interval [CI], 0.52-1.21), external jugular (HR, 0.79; CI, 0.33-3.13), subclavian (HR, 0.67; CI, 0.58-2.44) and femoral vein (HR, 1.20; CI, 0.36-1.33) catheters following multivariable analysis. There were no major differences in functionality or complications between the groups.
CONCLUSIONS: This
study identified no statistically significant relationship between tunnelled haemodialysis catheter insertion site and catheter survival. The contemporary approach to dialysis vascular access should be tailored to specific patient circumstances.