腹膜透析“pull”拔管术并发症的影响因素及防治

doi:10.3969/j.issn.1004-583X.2025.01.006

摘要/Abstract

摘要：

目的探讨腹膜透析(腹透)“pull”拔管术后并发症及其相关影响因素,进一步优化“pull”技术,减少并发症的发生。方法纳入2018年9月1日至2023年10月31日厦门大学附属中山医院等四家医院腹透中心的腹透患者98例及国内外公开发表关于腹透“pull”拔管术的文献(纳入中文和英文文献,排除样本量不足或描述不清的文献)中339例患者。比较其临床资料。结果腹透中心98例患者中13例出现并发症,多因素logistic回归分析提示体质量指数为腹透患者“pull”拔管术后出现并发症的独立危险因素(P<0.05)。与文献组比较,本研究组腹透管断裂、腹壁渗血占比均较大(P<0.05)。98例患者中腹透管断裂7例,可能与牵拉次数、牵拉角度、牵拉力度有关。98例患者中因拔管前外cuff距离皮肤出口小于2 cm或出口及外cuff感染8例,行改良的“pull”拔管术后,均未观察到并发症。因浅cuff反复感染及脱出7例,采用Seldinger法穿刺置管联合“pull”拔管术更换腹透管。结论 “pull”拔管术是一种简单、可行、经济、并发症少且可控的非侵入性拔管方法。

关键词: 腹膜透析, “pull”拔管术, 并发症, 影响因素分析

Abstract:

Objective To investigate the postoperative complications of the “pull” technique for peritoneal tube extubation in peritoneal dialysis (PD) patients and its influencing factors, and to further optimize the “pull” technique to reduce the incidence of complications. Methods From September 1, 2018 to October 31, 2023, 98 PD patients in peritoneal dialysis centers of four hospitals, including Zhongshan Hospital Xiamen University, and 339 PD patients extubated using the “pull” technique reported at home and abroad were analyzed. Literatures with a small sample size or unclear descriptions were excluded. The clinical data were compared. Results Complications occurred in 13 of the 98 patients in the dialysis center. Multivariate logistic regression analysis showed that body mass index (BMI) was an independent risk factor for the complications after the “pull” technique for peritoneal cathether extubation (P<0.05). Compared with the cases reported in literatures, the proportion of PD catheter rupture and abdominal wall bleeding in our study group was significantly larger (P<0.05). There were 7 cases of PD catheter rupture out of 98 patients, which may be related to the number of traction, traction angle and traction intensity. Among the 98 patients, there were 8 cases reporting the distance between the outer cuff and the skin outlet less than 2 cm or the infection of the outlet and the outer cuff before extubation, and no complications were observed after the modified “pull” technique for peritoneal cathether extubation. Due to repeated infection and prolapse of shallow cuff in 7 cases, Seldinger puncture catheterization combined with the “pull” technique for peritoneal cathether extubation was used to replace the PD catheter. Conclusion The “pull” technique for peritoneal catheter extubation is a safe and reliable technique with few and treatable complications.

Key words: peritoneal dialysis, “pull”technique, complication, root cause analysis

中图分类号:

R459.5

林则行, 郭汉城, 姚春萌, 肖良祥, 戴韵馨, 吴赛, 王福珍, 谢祖刚, 姚翠微. 腹膜透析“pull”拔管术并发症的影响因素及防治[J]. 临床荟萃, 2025, 40(1): 39-43.

Lin Zexing, Guo Hancheng, Yao Chunmeng, Xiao Liangxiang, Dai Yunxin, Wu Sai, Wang Fuzhen, Xie Zugang, Yao Cuiwei. Study on influencing factors and prevention for the complications of the “pull technique” technique for peritoneal catheter extubationremoval and the prevention[J]. Clinical Focus, 2025, 40(1): 39-43.

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链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2025.01.006

https://huicui.hebmu.edu.cn/CN/Y2025/V40/I1/39

图/表 7

表1 临床资料

Tab.1 Clinical characteristics

项目	数值
男性[例(%)]	68(69.4)
年龄(岁)	52.3±13.6
体质量指数(kg/m²)	22.0(20.3,23.0)
导管使用时间(月)	38.0(13.3,52.8)
血清白蛋白(g/L)	34.3(28.7,40.2)
血红蛋白(g/L)	99.3(83.1,107.9)
C反应蛋白(mg/L)	7.18(0.87,50.58)
白细胞(×10⁹/L)	7.47(5.95,8.91)
原发病因[例(%)]
糖尿病肾病	18(18.4)
高血压肾病	18(18.4)
慢性肾小球肾炎	52(53.1)
梗阻性肾病	1(1.0)
狼疮性肾病	3(3.1)
慢性肾盂肾炎	1(1.0)
尿酸性肾病	1(1.0)
遗传性肾病	2(2.0)
紫癜性肾炎	1(1.0)
乙肝相关性肾病	1(1.0)
拔管主要原因[例(%)]
腹膜炎	35(35.7)
导管功能不良	10(10.2)
转血液透析	25(25.5)
腹膜功能障碍	14(14.3)
渗漏和疝气	4(4.1)
肾移植	10(10.2)

表2 并发症组和无并发症组临床资料比较

Tab.2 Clinical data between complication and non-complication groups

组别	例数	男性 [例(%)]	年龄 (岁)	体质量指数 (kg/m²)	导管使用时间 (月)	血清白蛋白 (g/L)	血红蛋白 (g/L)	C反应蛋白 (mg/L)	白细胞计数 (×10⁹/L)
并发症组	13	6(46.2)	47.1±13.1	26.3(24.7,27.1)	47.0(23.5,80.5)	29.9(27.6,37.3)	88.0(77.5,107.5)	45.30(1.30,75.3)	9.90(6.90,12.90)
无并发症组	85	62(72.9)	52.9±13.9	21.3(19.6,22.4)	29.0(13.0,51.0)	35.2(30.7,40.8)	101.0(84.0,108.0)	1.35(0.80,46.80)	7.10(5.80,8.30)
$t$ / $Z$ /χ²值		2.650	-1.472	-5.534	-1.650	-1.380	-1.032	-1.995	-2.760
$P$ 值		0.103	0.144	<0.001	0.099	0.167	0.302	0.046	0.006

表2 并发症组和无并发症组临床资料比较

Tab.2 Clinical data between complication and non-complication groups

组别	例数	男性 [例(%)]	年龄 (岁)	体质量指数 (kg/m²)	导管使用时间 (月)	血清白蛋白 (g/L)	血红蛋白 (g/L)	C反应蛋白 (mg/L)	白细胞计数 (×10⁹/L)
并发症组	13	6(46.2)	47.1±13.1	26.3(24.7,27.1)	47.0(23.5,80.5)	29.9(27.6,37.3)	88.0(77.5,107.5)	45.30(1.30,75.3)	9.90(6.90,12.90)
无并发症组	85	62(72.9)	52.9±13.9	21.3(19.6,22.4)	29.0(13.0,51.0)	35.2(30.7,40.8)	101.0(84.0,108.0)	1.35(0.80,46.80)	7.10(5.80,8.30)
$t$ / $Z$ /χ²值		2.650	-1.472	-5.534	-1.650	-1.380	-1.032	-1.995	-2.760
$P$ 值		0.103	0.144	<0.001	0.099	0.167	0.302	0.046	0.006

表3 腹透患者“pull”拔管术后并发症影响因素的多因素logistic回归分析

Tab.3 Multivariate logistic regression analysis for influencing factors of complications in PD patients after “pull” technique

因素	β	SE	Wald χ²值	$O R$ 值	$P$ 值	95% $C I$
因素	β	SE	Wald χ²值	$O R$ 值	$P$ 值	下限	上限
体质量指数	2.199	0.837	6.900	9.015	0.009	1.740	46.500
白细胞计数	0.071	0.354	0.043	1.074	0.836	0.150	2.110
C反应蛋白	0.015	0.014	1.015	1.015	0.283	0.980	1.040

表3 腹透患者“pull”拔管术后并发症影响因素的多因素logistic回归分析

Tab.3 Multivariate logistic regression analysis for influencing factors of complications in PD patients after “pull” technique

因素	β	SE	Wald χ²值	$O R$ 值	$P$ 值	95% $C I$
因素	β	SE	Wald χ²值	$O R$ 值	$P$ 值	下限	上限
体质量指数	2.199	0.837	6.900	9.015	0.009	1.740	46.500
白细胞计数	0.071	0.354	0.043	1.074	0.836	0.150	2.110
C反应蛋白	0.015	0.014	1.015	1.015	0.283	0.980	1.040

表4 本研究组和文献组临床资料比较[例(%)]

Tab.4 Clinical data between the cases reported in our study and literatures

组别	例数	男性	拔管主要原因
组别	例数	男性	腹膜炎	转血液透析	腹膜功能障碍	导管功能不良	肾移植
本研究组	98	68(69.4)	35(35.7)	25(25.5)	14(14.3)	10(10.2)	10(10.2)
文献组	339	209(61.7)	138(40.7)	69(20.4)	40(11.8)	39(11.5)	47(13.9)
χ²值		1.960	0.793	1.197	0.434	0.129	0.898
$P$ 值		0.161	0.373	0.274	0.510	0.719	0.343

表4 本研究组和文献组临床资料比较[例(%)]

Tab.4 Clinical data between the cases reported in our study and literatures

组别	例数	男性	拔管主要原因
组别	例数	男性	腹膜炎	转血液透析	腹膜功能障碍	导管功能不良	肾移植
本研究组	98	68(69.4)	35(35.7)	25(25.5)	14(14.3)	10(10.2)	10(10.2)
文献组	339	209(61.7)	138(40.7)	69(20.4)	40(11.8)	39(11.5)	47(13.9)
χ²值		1.960	0.793	1.197	0.434	0.129	0.898
$P$ 值		0.161	0.373	0.274	0.510	0.719	0.343

表5 本研究组和文献组术后并发症比较[例(%)]

Tab.5 Postoperative complications between the cases reported in our study and literatures

组别	例数	腹透管断裂	外cuff感染	内cuff感染	腹壁渗血	腹水渗漏
本研究组	98	7(7.1)	2(2.0)	1(1.0)	4(4.1)	2(2.0)
文献组	339	4(1.2)	19(5.6)	8(2.4)	1(0.3)	5(1.5)
χ²值		8.720	1.404	0.175	6.580	0.000
$P$ 值		0.003	0.236	0.676	0.010	1.000

表5 本研究组和文献组术后并发症比较[例(%)]

Tab.5 Postoperative complications between the cases reported in our study and literatures

组别	例数	腹透管断裂	外cuff感染	内cuff感染	腹壁渗血	腹水渗漏
本研究组	98	7(7.1)	2(2.0)	1(1.0)	4(4.1)	2(2.0)
文献组	339	4(1.2)	19(5.6)	8(2.4)	1(0.3)	5(1.5)
χ²值		8.720	1.404	0.175	6.580	0.000
$P$ 值		0.003	0.236	0.676	0.010	1.000

表6 IPD组和NIPD组并发症比较[例(%)]

Tab.6 Complications between IPD and NIPD groups

组别	例数	腹透管断裂	外cuff感染	内cuff感染	腹壁渗血	腹水渗漏
IPD组	35	2(5.7)	2(5.7)	1(2.9)	3(8.6)	1(2.9)
NIPD组	63	5(7.9)	0(0)	0(0)	1(1.6)	1(1.6)
χ²值		0.000	1.372	0.090	1.303	0.000
$P$ 值		1.000	0.241	0.764	0.254	1.000

表6 IPD组和NIPD组并发症比较[例(%)]

Tab.6 Complications between IPD and NIPD groups

组别	例数	腹透管断裂	外cuff感染	内cuff感染	腹壁渗血	腹水渗漏
IPD组	35	2(5.7)	2(5.7)	1(2.9)	3(8.6)	1(2.9)
NIPD组	63	5(7.9)	0(0)	0(0)	1(1.6)	1(1.6)
χ²值		0.000	1.372	0.090	1.303	0.000
$P$ 值		1.000	0.241	0.764	0.254	1.000

表7 腹透管断裂组和非腹透管断裂组临床资料比较

Tab.7 Clinical data between PD catheter rupture and non-PD catheter rupture groups

组别	例数	牵拉次数	牵拉角度 (°)	牵拉力度 >15磅[例(%)]
腹透管断裂组	7	3(3,4)	50(45,50)	6(85.7)
非腹透管断裂组	91	11(9,12)	20(15,20)	1(1.1)
χ²/ $Z$ 值		-4.430	-4.707	57.988
$P$ 值		<0.001	<0.001	<0.001

表7 腹透管断裂组和非腹透管断裂组临床资料比较

Tab.7 Clinical data between PD catheter rupture and non-PD catheter rupture groups

组别	例数	牵拉次数	牵拉角度 (°)	牵拉力度 >15磅[例(%)]
腹透管断裂组	7	3(3,4)	50(45,50)	6(85.7)
非腹透管断裂组	91	11(9,12)	20(15,20)	1(1.1)
χ²/ $Z$ 值		-4.430	-4.707	57.988
$P$ 值		<0.001	<0.001	<0.001

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