A multicenter, prospective, randomized, comparative evaluation of dual- versus triple-lumen catheters for hemodialysis and apheresis in 485 patients.
A multicenter, prospective, randomized, comparative evaluation of dual- versus triple-lumen catheters for hemodialysis and apheresis in 485 patients.
复制标题
对 485 名患者进行血液透析和血浆分离术的双腔导管与三腔导管的多中心、前瞻性、随机比较评估。
DOI：
10.1016/s0272-6386(03)00657-7
复制
发表时间：
2003
期刊：
影响因子：
--
通讯作者：
J. Pulliam
中科院分区：
文献类型：
--
作者：
G. Contreras;Ping;L. Elzinga;M. Anger;Jean Lee;N. Robert;R. Chvala;R. L. Mars;T. Vesely;T. Taber;D. Shemin;R. Shafritz;J. Pulliam
本研究的目的是比较一种新的临时三腔透析导管（TLC），其第三腔专用于液体和药物管理或血液采样，并与市售双腔导管（DLC）进行比较。对464名患者进行了血流速度的分析（228例患者，DLC; 236例患者，TLC），共计1，681次血液透析（808次治疗，DLC; 873次治疗，TLC）和82次单采治疗（37次治疗，DLC; 45次治疗，TLC）。血液透析期间，两组的中位实现流速（AFR）均为267 mL/min（P = 0.58）。单采期间，DLC组的中位AFR为72.5 mL/min（范围：50 - 150 mL/min），TLC组为87 mL/min（范围：60 - 150 mL/min）（P = 0.14）。393例患者（193例患者，DLC; 200例患者，TLC）在取出时进行了血液和导管头端培养，并确定了导管相关血流感染（CRBSI）状态。31例患者（7.9%）发生CRBSI：16例患者（8.3%）为DLC; 15例患者（7.5%）为TLC（P= 0.77）。CRBSI的发病率密度分别为12.4/1，000 DLC-days和10.2/1，000 TLC-days（P = 0.59）。股静脉部位的CRBSI发生率为18.2/1000导管-天，显著高于颈静脉部位的7/1,000导管-天（P = 0.02）和颈静脉和锁骨下联合部位的6.6/1000导管-天（P = 0.01）。在多变量分析中，抗生素使用是CRBSI的唯一相关因素（比值比，0.30; 95%置信区间，0.12 - 0.76）。其他并发症的发生率在2种导管之间无统计学显著差异。结论结果表明，新的TLC与市售的DLC相似。
BACKGROUNDThe purpose of this study is to compare a new temporary triple-lumen catheter (TLC) for dialysis that has a third lumen devoted to fluid and medication administration or blood sampling with a marketed dual-lumen catheter (DLC).METHODSFour hundred eighty-five patients referred for acute hemodialysis or apheresis were randomly assigned to either a TLC or DLC in a multicenter, prospective, randomized trial.RESULTSAnalysis of blood flow rates was completed on 464 patients (228 patients, DLC; 236 patients, TLC) with a total of 1,681 hemodialysis (808 treatments, DLC; 873 treatments, TLC) and 82 apheresis treatments (37 treatments, DLC; 45 treatments, TLC). During hemodialysis, a median achieved flow rate (AFR) of 267 mL/min was realized for both groups (P = 0.58). During apheresis, a median AFR of 72.5 mL/min (range, 50 to 150 mL/min) was achieved in the DLC group, and 87 mL/min (range, 60 to 150 mL/min), in the TLC group (P = 0.14). Three hundred ninety-three patients (193 patients, DLC; 200 patients, TLC) had blood and catheter tip cultures performed on removal, and catheter-related bloodstream infection (CRBSI) status was determined. Thirty-one patients (7.9%) had a CRBSI: 16 patients (8.3%), DLC; and 15 patients (7.5%), TLC (P= 0.77). Incidence densities of CRBSI were 12.4/1,000 DLC-days and 10.2/1,000 TLC-days (P = 0.59). The CRBSI incidence of 18.2/1,000 catheter-days for femoral sites was significantly greater than the 7/1,000 catheter-days for jugular sites (P = 0.02) and 6.6/1,000 catheter-days for combined jugular and subclavian sites (P = 0.01). In multivariate analysis, antibiotic use was the only factor related to CRBSI (odds ratio, 0.30; 95% confidence interval, 0.12 to 0.76). There were no statistically significant differences in rates of other complications between the 2 catheters.CONCLUSIONResults show that the new TLC is similar to the marketed DLC.