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隧道式带涤纶套的血液透析导管相关性菌血症

Authors
Michael Allon, MD
Daniel J Sexton, MD
Section Editor
Jeffrey S Berns, MD
Deputy Editors
Alice M Sheridan, MD
Kathryn A Collins, MD, PhD, FACS
Translators
周莉, 副主任医师

引言和概述

中心静脉导管，最初是作为短期透析使用的血管通路，现在已经成为一种可以接受的永久性血管通路形式。非隧道式不带涤纶套的导管和隧道式带涤纶套的导管均可用。目前，隧道式带涤纶套的双腔硅胶导管是透析患者优选的短期和中期使用的通路[1]。在一些患者中这种导管也被用作永久性血管通路，特别是对于其他替代血管通路选择有限的患者[1]。

人们变得倾向于动静脉(arteriovenous, AV)瘘而非AV移植物，这在很大程度上使得非隧道式导管过渡为隧道式、带涤纶套的导管。因为动静脉瘘与移植物相比，需要更长的成熟时间，在血液透析患者中依赖导管作为血管通路的持续时间也大幅增加[2]。另外，大约80%的新发透析患者透析初始阶段使用的是导管。 (参见“长期血液透析通路用动静脉瘘及人工血管内瘘”)

隧道式带涤纶套的导管与一些并发症相关，特别是导管相关性菌血症。在血液透析患者中导管相关性菌血症的临床影响已在一些研究中得到量化[3-6]。例如在HEMO研究中，所有患者中有7.6%使用导管作为血管通路，但是该患者组包含了整个研究中通路相关性感染住院患者的32%[6]。在另一项前瞻性研究中，2666进行肾脏替代治疗的苏格兰患者中，使用隧道式导管作为透析通路的患者其全因死亡和感染相关性死亡的比数是只使用AV瘘或移植物作为透析通路的患者的6.9倍[7]。但是，尽管有这些风险，并且国内国际指南推荐AV瘘作为优选的透析通路形式，但在许多国家使用隧道式导管作为透析通路的患者比例仍然稳步上升[8]。

对隧道式带涤纶套的透析导管相关性菌血症的概述见此专题。其他导管相关的并发症，如血栓形成将单独讨论。 (参见“Thrombosis associated with chronic hemodialysis vascular catheters”)

流行病学

导管相关性菌血症 — 血液透析患者中大多数的菌血症是由于血管通路导管感染所致。使用留置隧道式导管的患者菌血症发生率高于那些使用AV瘘或合成移植物的患者[5,9]。在透析患者中使用隧道式透析导管所致菌血症的相对危险度据估计约为使用AV瘘患者的10倍[10]。另外，依赖导管进行血液透析的患者感染相关性住院和感染相关性死亡的风险，是使用AV瘘或移植物做透析的患者的2-3倍[11,12]。

                                  

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Literature review current through: 2017-06 . | This topic last updated: 2016-01-27.
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