【摘要】目的探讨维持性血液透析(maintenance hemodialysis，MHD)患者带隧道带涤纶套导管(tunneled-cuffed catheter, TCC)意外脱管的影响因素。方法对福建医科大学附属第一医院2016年1 月～2021 年6 月TCC 意外脱管的21 例血液透析患者进行回顾性分析，采用系统抽样法抽取导管固定在位患者77 例为对照组，收集2 组临床一般资料及实验室资料作为观察项目，比较2 组资料，用Logistic 回归分析TCC 意外脱管的相关危险因素。结果同期符合入组标准共445 例患者，意外脱管率4.72%，Logistic 回归分析显示导管出口线结反应(OR=9.289,95% CI:1.767～48.841,P=0.008)、中性粒细胞与淋巴细胞比值(OR=1.659,95% CI:1.05～2.613, P= 0.029)、血白蛋白(OR=0.813,95% CI:0.671～0.986, P=0.035)、血磷(OR=5.528,95% CI:1.486～20.560,P=0.011)为TCC 意外脱管独立危险因素。结论MHD患者TCC 意外脱管与导管出口线结反应、中性粒细胞与淋巴细胞比值、血白蛋白及血磷相关，提示积极控
制局部及全身炎症、改善营养状态、控制血磷可能对预防TCC 意外脱管有一定临床指导意义。
【Abstract】Objective To investigate the influencing factors relating to the accidental exit of tunneledcuffed catheter (TCC) in patients with maintenance hemodialysis (MHD). Methods Twenty-one MHD patients having the accidental exit of TCC during January 2016 to June 2021 treated in The First Affiliated Hospital of Fujian Medical University were retrospectively analyzed. Seventy- seven cases with TCC fixed in place were obtained by the system sampling method as the control group. Clinical data and laboratory results as the observation items were collected and compared between the two groups. Logistic regression was used
to analyze the relevant risk factors for accidental exit of TCC. Results There were 445 cases who met entry criteria in the period, and the rate of accidental exit was 4.72%. Multivariate regression analysis suggested that suture reaction at the TCC exit site (OR=9.289, 95% CI: 1.767～48.841, P=0.008), neutrophil to lymphocyte ratio (NLR) (OR=1.659, 95% CI: 1.053～2.613, P= 0.029), serum albumin (ALB) (OR=0.813, 95% CI:0.671～0.986, P=0.035) and serum phosphate (P) (OR=5.528, 95% CI: 1.486～20.560, P=0.011) were the independent risk factors for accidental exit of TCC. Conclusions Suture reaction at the TCC exit site, NLR, ALB and P are the independent risk factors relating to accidental exit of TCC in MHD patient. Therefore, effective control of local and systemic inflammation, improvement of nutritional status, and active control of blood phosphate may have clinical significance for preventing accidental exit of TCC.
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