Please use this identifier to cite or link to this item: http://hdl.handle.net/11455/13367
標題: 影響小動物急性腎衰竭之預後指標與犬隻使用中央靜脈導管相關感染之評估
Prognostic Indicators Affecting the Outcome of Acute Renal Failure in Small Animals and Evaluation of Related Infection by Using Central Venous Catheter in Dogs
作者: 林凱威
Lin, Kai-Wei
關鍵字: acute renal failure
急性腎衰竭
prognosis
catheter
infection
預後
導管
感染
出版社: 獸醫學系暨研究所
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摘要: 腎衰竭為動物臨床上常見疾病之一。當有腎衰竭發生時,即表示有75%以上的腎元失去正常生理功能,進而導致代謝廢物的累積,液體、電解質與酸鹼的不平衡。雖然急性腎衰竭導致的腎臟損傷是可逆性的,但急性腎衰竭在不同治療方式下(如傳統輸液療法、腹膜透析與血液透析療法),仍有30-83%的致死率。另一方面,中央途徑的血管通路(如中央靜脈導管)可用以輸液治療與多次採血,但由於導管相關感染(catheter-related infection)的情形,往往限制這類導管的使用並導致血管通路的喪失。本研究的實驗目的主要分為兩部分,第一部份為收集急性腎衰竭動物的基本資料、出現臨床症狀、伴隨疾病與臨床病理學、尿液學和血液氣體分析的結果,調查影響急性腎衰竭犬貓的相關預後因子。於2000年一月至2006年十二月間,共有1,339個犬隻病例與241個貓隻病例因腎衰竭就診於中興大學獸醫獸醫教學醫院。腎衰竭之年盛行率與致死率在犬隻分別為4-10%與49-59%,在貓隻則為2-10%與33-62%。在判定為急性腎衰竭的動物中(501為犬隻、69為貓隻),犬貓整體致死率分別為81.2%與65.2%。調查結果顯示在犬隻若住院天數 ≦ 5天、就診時體溫 ≦ 37.4℃、氮血症較嚴重(BUN > 100.0 mg/dL、creatinine > 6.0 mg/dL)、血中磷離子(> 10.0 mg/dL)與鈣磷乘積(> 60.0 mg2/dL2)較高和出現蛋白尿(> 25.0 mg/dL)者,會有較高的致死率,然而在貓隻,僅發現住院天數(≦ 4天)與就診時體溫 ≦ 37.6℃者,會影響貓隻的存活率。本研究另一部份為將中央靜脈導管放置於8隻健康犬隻之頸靜脈內,進行6天的實驗期,期間由導管周圍皮膚、導管中心內外圍、導管於皮下與尖端的部分進行採樣,並採集血液進行微生物培養,評估中央靜脈導管相關感染的情形。結果顯示並無發現任何導管相關感染的現象。不過在導管放置後第三天與第六天,由導管周圍皮膚與導管中心外圍所分離到的菌株中,以革蘭氏陽性菌佔多數,特別是Bacillus sp.( 37.5% )、Staphylococcus epidermidis ( 25.0% )與Micrococcus luteus ( 25.0% ),且這些菌株對多數抗生素皆具敏感性,以penicillin、cefazolin、chloramphenicol與enrofloxacin等抗生素敏感性較佳。由本研究可知,在患有急性腎衰竭的犬隻,若就診時呈現較嚴重的氮血症與電解質不平衡時,會有較差的預後。另外,中央靜脈導管未來可安全應用於腎衰竭的動物上,作為長期輸液與採血途徑,並進行中央靜脈壓的監控。
Renal failure is one of the most common diseases in practice and contributes to retention of metabolic toxins and derangement of electrolyte balance. Although renal damage resulting from acute renal failure (ARF) is reversible, the mortality rates of ARF following different treatments were determined between 30-83%. Vascular access of central line such as central venous catheter (CVC) allows for reliable fluid therapy, the key in treating ARF and frequent blood sampling. However, catheter-related infection significantly limits the use of catheters and causes vascular access loss. The purpose of this study was to access the prognostic indicators associated with ARF for small animals in central Taiwan. In addition, we evaluated the catheter-related infection induced by using CVC in dogs. A total of 1,339 dogs and 241 cats with renal failure were admitted to Veterinary Medicine Teaching Hospital of NCHU from January 2000 to December 2006. The yearly prevalence of renal failure in dogs and cats was 5-10% and 2-10%, respectively. Among 501 dogs and 69 cats with ARF, the mortality rates were 81.2% and 65.2%, respectively. The clinical parameters such as hospitalized day (≦ 5 day), body temperature (≦ 37.4℃), the magnitude of azotemia (BUN > 100.0 mg/dL, creatinine > 6.0 mg/dL), the concentrations of serum phosphorus(> 10.0 mg/dL) and calcium × phosphorus product (> 60.0 mg2/dL2), and severity of proteinuria(> 25.0 mg/dL) at initial presentation were identified to be associated with high mortality in dogs, while in cats, only hospitalized day (≦ 4 day) and body temperature (≦ 37.6℃) at initial presentation were identified to be associated with mortality. The application of CVC was performed to eight health adult dogs in a period of 6-day-experment. Skin of insertion site and external surface of catheter hub were cultured for bacteria. Blood cultures were obtained through the distal part of catheter before catheter removal. The results of the culture indicated that gram-positive bacteria were mostly isolated from skin of insertion site and external surface of catheter hub on the 3rd and 6th day after CVC insertion, especially for Bacillus sp. (37.5%), Staphylococcus epidermidis (25.0%), and Micrococcus luteus (25.0%), which were susceptible to penicillin, cefazolin, chloramphenicol and enrofloxacin. In conclusions, canine ARF with severe azotemia and electrolytes disorders is significantly associated with poor outcome. The application of CVC in small animals with renal failure would be safe for a long-term fluid therapy and central venous pressure monitoring in the future.
URI: http://hdl.handle.net/11455/13367
其他識別: U0005-1107200715040300
文章連結: http://www.airitilibrary.com/Publication/alDetailedMesh1?DocID=U0005-1107200715040300
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