우리나라 일개 병원 암 환자에서 중심정맥관 합병증에 관한 후향적 조사 = Retrospective Analysis for Complications of the Central Venous Catheter in Patients with Cancer at a Single Center in Korea

국문 초록 (Abstract)

목적: 암환자에게 있어 중심 정맥관 삽입은 항암치료나 수혈, 비경구 영양공급 목적으로 흔히 시행된다. 중심정맥관 삽입으로 인해 발생하는 합병증으로는 감염, 혈전, 물리적 합병증이 있는데, 이 연구는 합병증의 빈도와 관련 인자들을 규명하기 위해 계획되었다. 방법: 2001년 3월부터 2006년 8월까지 중심 정맥관을 삽입한 고형암과 혈액암 환자를 대상으로 경과기록 분석을 통한 후향적 연구를 시행하였다. 감염, 혈전, 물리적 합병증 각각의 빈도를 조사하였고, 감염과 혈전의 발생에 영향을 미치는 여러 인자들과 그 연관성을 분석하기 위해 교차 분석을 사용하였다. 또한, 삽입관 수명에 영향을 미치는 인자들을 알기 위해 단변량 분석에는 log-rank test를 이용한 Kaplan-Meier 방법과 다변량 분석에는 Cox regression analysis 를 사용하였다. 결과: 310명의 암환자들에게 310개의 중심 정맥관 삽입이 시술되었고, 남자 157명, 여자 153명이었고, 혈액암 환자가 132명, 고형암 환자 178명이었으며, 평균 연령은 52세였다(range: 15~82). 60예(19%)의 환자에서 합병증이 나타났으며, 혈전을 가진 환자에서 감염이 더 빈번하게 일어났고(P=0.003), 암이나 삽입관의 종류, 수혈 및 비경구 영양 시행 여부와 합병증 발생과는 큰 연관성이 없었다. 삽입관의 평균수명은 99일(range: 2~1,330)이었는데 삽입관의 수명은 터널식 삽입관(P=0.000)을 가진 경우에, 그리고 중심정맥관을 통해 수혈을 하지 않은 경우(P=0.030) 더 연장되었다. 결론: 중심 정맥관 삽입의 주요 합병증은 혈전과 감염이었다. 터널식 정맥관은 장기적인 사용에 효과적인 방법이며, 특히 중심정맥관을 통해 수혈을 받지 않는 경우에 그러하다. 중심 정맥관 장기 사용을 위해 혈전과 감염의 예방 및 치료에 대한 연구가 더욱 이루어져야할 것으로 여겨진다.

다국어 초록 (Multilingual Abstract)

Purpose: A central venous catheterization (CVC) is frequently used for delivering anti-cancer chemotherapeutic agents, blood products, parenteral nutrition, and other intravenous therapy in patients with cancer. Major complications of CVC use are thrombosis, infection, and mechanical complications. The aim of this study was to evaluate the frequency of CVC complications and related factors. Methods: The records of cancer patients who received a CVC at our university hospital from March 2001 to October 2006 were retrospectively investigated. Chi square test was used to determine whether there was a related factor for thrombosis or infection, and Kaplan-Meier analysis for univariate analysis, or Cox-regression analysis for multivariate analysis was used for catheter life span. Results: Three hundred and ten CVCs (235 nontunneled, 75 tunneled) were inserted in 310 patients (157 males, 153 females). Among them, 104 had hematologic cancers and 206 had solid cancers. The mean age of the patients was 52 years (range, 19~82 years). CVC complications occurred in 60 cases (19%). CVC-related thrombosis occurred frequently in patients with infection (P=0.003), whereas diagnosis, catheter type, transfusion, and TPN history did not affect infection or thrombosis. The mean duration of the catheter was 102 days (range, 2~1,330 days), and the duration was prolonged in patients with tunneled catheters (P=0.000), or without transfusion through CVC (P=0.030). Conclusion: The major complications for long-term use of a CVC were infectionand thrombosis. Tunneled catheter was effective tool for long term use, especially in cases without transfusion through CVC. The studies on the prevention or treatment ofthrombosis and infection are, therefore, warranted by using CVC for an extended period of time.

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