혈액 투석 환자에서 중심 정맥 도관의 세균 집락에 관한 연구: Cuffed & Tunnelled Dialysis Catheter (Permcath )와Noncuffed Dialysis Catheter (Gamcath )의 비교 = Catheter Colonization in Hemodialysis Patients: Comparison with Cuffed & Tunnelled Dialysis Catheter (Permcath ) and Noncuffed Dialysis Catheter (Gamcath )

다국어 초록 (Multilingual Abstract)

Purpose: The aim of this study is to investigate incidence and related affecting factors on bacterial colonization and bacteremia of cuffed & tunnelled dialysis catheter and noncuffed dialysis catheter.
Methods: This study was performed retrospectively through review of medical records from May 2005 to May 2006. 102 central venous catheters for hemodialysis were analyzed: cuffed & tunnelled dialysis catheter (n=32, group P); noncuffed dialysis catheter (n=70, group G).
Results: There was no difference between group P (15.6%) and group G (15.7%) in cumulative incidence of catheter colonization. However, in terms of risk for colonization with time, incidence density of group P was lower than group G (group P, 1.17/1,000 catheter days; group G, 12.97/ 1,000 catheter days). In the subgroup analysis of group G, incidence density of internal jugular vein group was lower than femoral vein group (internal jugular vein catheter, 7.54/1,000 catheter days; femoral vein catheter, 32.43/1,000 catheter days).
Conclusion: The risk of catheter colonization turned out higher in noncuffed dialysis catheter than in cuffed & tunnelled dialysis catheter. Therefore, more delicate antiseptic cares for dialysis catheter were needed in case of emergency. Additionally, permanent vascular access should be placed earlier to avoid insertion of temporary dialysis catheter in end-stage renal disease.

국문 초록 (Abstract)

목 적 : 중심정맥도관으로 주로 사용되는 Cuffed & Tunnelled Dialysis Catheter (Permcath)와 Noncuffed Dialysis Catheter (Gamcath)에서 도관제거시 균집락 상태 및 균혈증과의 관계를 파악하고 각 도관 사이를 비교하여 Cuffed & Tunnelled Dialysis Catheter의 안전성을 알아보고자 시행되었다.
방 법 : 2005년 5월부터 2006년 5월까지 본원 신장내과에서 급성, 만성 신부전으로 혈액투석을 시행하였던 환자 중 후향적으로 분석이 가능했던 102건의 중심정맥 도관을 대상으로 균집락 및 균혈증 상태를 알아보았다. Cuffed & Tunnelled Dialysis Catheter (P군)은 32건, Noncuffed Dialysis Catheter (G군)은 70건이었다.
결 과 : P군은 5례 (15.6%)에서 균집락을 확인하였고 G군은 11례 (15.7%)에서 균집락을 확인하였다. P군에서 2례 (MRSA), G군에서 1례 (Acinetobacter baumaii)의 균혈증을 동반하였고 이에 따른 증상이 있어 도관을 제거하게 되었다. 양군에서 도관삽입 기간에 따른 균집락 위험도를 분석하였을 때 P군에서 균집락의 위험도가 낮게 나타났으며 G군에서는 높게 나타났으나, 내경정맥 사용군에서는 균집락의 위험도가 적었다 (균집락 평균 발생율: P군 1.17/1,000 catheter days, G군 12.97/1,000 catheter days; 대퇴정맥 32.43/ 1,000 catheter days, 내경정맥 7.54/1,000 catheter days; 균혈증 평균 발생율: P군 0.46/1,000 catheter days, G군 1.18/1,000 catheter days).
결 론 : 응급으로 시행했던 Noncuffed Dialysis Catheter 에서 균집락의 평균 발생율이 높았으며 향후 균혈증으로의 발생 가능성이 높을 것으로 예측할 수 있다. 따라서 급성기에 시행한 중심정맥도관의 관리에 좀더 세심한 주의가 필요할 것이며 특히 만성 신부전에서는 급성상황을 피해 영구적 동정맥루을 조기에 만드는 것이 좋을 것이다.

참고문헌 (Reference)

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