在单个中心四年内插入1000多个带套管的隧道式血液透析导管的经验
Experience With More Than 1,000 Cuffed Tunneled Hemodialysis Catheter Insertions Over Four Years at a Single Center.
摘要(中文译文)
带 cuff 的隧道式血液透析导管是终末期肾病（ESRD）患者在无法建立动静脉内瘘（AVF）或需要紧急启动血液透析时的重要血管通路选择。然而，临床结局可能因导管置入部位不同而有所差异。本研究旨在比较不同隧道式血液透析导管置入部位的手术安全性、生化结局及六个月临床结局。本回顾性观察研究纳入了一家三级医疗中心四年内连续接受隧道式血液透析导管置入的1,050例患者。根据导管置入部位将患者分为右颈内静脉组（RIJV；535例）、左颈内静脉组（LIJV；416例）、锁骨下静脉组（53例）和股静脉组（46例）。采用适当的统计学方法比较基线特征、手术相关并发症、三个月时的实验室结局及六个月时的临床结局。各组间基线人口学和实验室特征具有可比性（均P>0.05）。锁骨下静脉组和股静脉组的手术相关并发症显著更频繁，包括出口部位出血（P=0.032）、导管异位（P=0.028）、血肿形成（P=0.018）、动脉穿刺（P=0.022）、低氧血症（P=0.036）、心律失常（P=0.041）和气胸（P=0.048）。三个月时，锁骨下静脉和股静脉通路患者的生化指标显著较差，表现为血红蛋白和血清白蛋白水平较低，白细胞计数、血清肌酐、C反应蛋白、磷和全段甲状旁腺激素水平较高（均P<0.05）。六个月时，颈内静脉通路与显著更高的AVF成功建立率（P=0.018）和导管持续存活率（P=0.012）相关。相反，锁骨下静脉和股静脉通路与显著更高的导管功能障碍率（P=0.015）、导管相关血流感染率（P=0.013）和死亡率（P=0.020）相关。与锁骨下静脉和股静脉通路相比，颈内静脉通路，尤其是右颈内静脉通路，与更优的手术安全性、更有利的生化指标及更好的六个月临床结局相关。这些发现支持在条件允许时优先选择颈内静脉通路进行隧道式血液透析导管置入。
Abstract
Cuffed tunneled hemodialysis catheters are an important vascular access option for patients with end-stage renal disease (ESRD) when arteriovenous fistula (AVF) creation is not feasible or when urgent initiation of hemodialysis is required. However, clinical outcomes may vary according to the catheter insertion site. To compare procedural safety, biochemical outcomes, and six-month clinical outcomes among different tunneled hemodialysis catheter insertion sites. This retrospective observational study included 1,050 consecutive patients who underwent tunneled hemodialysis catheter insertion over four years at a tertiary care center. Patients were categorized according to catheter insertion site into right internal jugular vein (RIJV; = 535), left internal jugular vein (LIJV; = 416), subclavian vein (= 53), and femoral vein (= 46) groups. Baseline characteristics, procedure-related complications, laboratory outcomes at three months, and clinical outcomes at six months were compared using appropriate statistical analyses. Baseline demographic and laboratory characteristics were comparable among all groups (all > 0.05). Procedure-related complications were significantly more frequent in the subclavian and femoral groups, including exit-site bleeding (= 0.032), catheter malposition (= 0.028), hematoma formation (= 0.018), arterial puncture (= 0.022), hypoxia (= 0.036), arrhythmia (= 0.041), and pneumothorax (= 0.048). At three months, patients with subclavian and femoral access demonstrated significantly poorer biochemical profiles, characterized by lower hemoglobin and serum albumin levels and higher leukocyte counts, serum creatinine, C-reactive protein, phosphorus, and intact parathyroid hormone levels (all p<0.05). At six months, internal jugular vein access was associated with significantly higher rates of successful AVF creation (= 0.018) and ongoing catheter survival (= 0.012). Conversely, subclavian and femoral access were associated with significantly higher rates of catheter dysfunction (= 0.015), catheter-related bloodstream infection (= 0.013), and mortality (= 0.020). Internal jugular vein access, particularly RIJV access, was associated with superior procedural safety, more favorable biochemical profiles, and better six-month clinical outcomes compared with subclavian and femoral access. These findings support the preferential use of internal jugular vein access for tunneled hemodialysis catheter placement whenever feasible.
如何引用
AMA
Maulik A Patel, Pranjal Kashiv, Khushboo Saxena, Manish Balwani, Vivek Kute. Experience With More Than 1,000 Cuffed Tunneled Hemodialysis Catheter Insertions Over Four Years at a Single Center.. Cureus. 2026; doi:10.7759/cureus.111073.
APA
Maulik A Patel, Pranjal Kashiv, Khushboo Saxena, Manish Balwani, Vivek Kute (2026). Experience With More Than 1,000 Cuffed Tunneled Hemodialysis Catheter Insertions Over Four Years at a Single Center.. Cureus. https://doi.org/10.7759/cureus.111073
GB/T 7714
Maulik A Patel, Pranjal Kashiv, Khushboo Saxena, Manish Balwani, Vivek Kute. Experience With More Than 1,000 Cuffed Tunneled Hemodialysis Catheter Insertions Over Four Years at a Single Center.[J]. Cureus, 2026 doi:10.7759/cureus.111073.
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