혈액투석 환자에게서 BioholeTM 쐐기를 이용한 Buttonhole 천자법의 임상적 유용성
Clinical Utility of the Buttonhole Technique Using BioholeTM in Hemodialysis Patients
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목적:지금까지 혈액투석에서 같은 부위를 천자하는 buttonhole법이 천자가 쉽고, 지혈이 빠르고, 통증과 감염 등의 합병증이 적은 것으로 알려졌으나, 숙련된 인력과 긴 시간 등의 단점이 있었는데, 최근 BioholeTM을 이용하여 2주 만에 통로를 확보하는 새로운 buttonhole법이 소개되어 북미, 일본 등지에서 사용되고 있다. 방법:순천향대학교 부천병원에서 혈액투석을 3개월 이상 받는 환자들을 대상으로 2011년 7월부터 10월까지 기존의 rope-ladder법으로 투석 받는 군과 BioholeTM을 이용하여 경로를 만들고 이후 buttonhole법의 천자를 받는 환자군의 2주간의 시술 과정과 시술 후 12주간 결과를 비교 연구하였다. 결과:총 40명(남자 27명)의 환자가 포함되었고 평균 나이는 49.1 ± 14.2세(22-84세)이고, 투석 기간은 60.0 ± 58.2개월(4-264개월)이었다. rope-ladder군은 13명, buttonhole군은 27명이었고, 시험군에서 체중(p = 0.004)이 많이 나갔고, 통증의 강도(p = 0.044)가 높았다. BioholeTM을 이용한 2주간의 경로 형성에서 buttonhole군 환자들의 천자 시 통증(5.6 ± 2.7 vs. 3.4 ± 3.1, p = 0.003)이 감소하고, 지혈 시간(1.8 ± 0.5 vs. 1.3 ± 0.5, p = 0.001)은 단축되었다. BioholeTM 시술 2주간에 부작용으로 쐐기의 이탈(20.8%), 쐐기 부위 출혈(8.6%), 통증(2.4%)의 순으로 발생하였고, 모든 환자에서 염증과 감염사건은 없었다. BioholeTM 시술 후 12주간에 buttonhole군에서 rope-ladder군에 비해 통증은 감소하였고(p = 0.088), 감염이 1예(p = 0.327)가 발생하였으나 통계적 의미가 없었고, 지혈은 더 잘되었다(p = 0.000). 결론: BioholeTM을 이용한 새로운 buttonhole 천자법은 안전하고 유용하나, 장기적인 대규모 연구가 요망된다.
Abstract
Background/Aims:Buttonhole cannulation has been popular because it provides an easy puncture, is less painful, and requires less time for hemostasis. However, the technique requires a skilled staff and a long time to form the tract. A new buttonhole technique using BioholeTM, which shortens the time needed for tract formation, has been introduced in Europe, North America, and Japan. Methods:We prepared a cannulation tract using the buttonhole technique and BioholeTM over a two-week period and compared the 12-week outcomes between patients who underwent the rope-ladder versus buttonhole techniques. Results:The 40 patients (27 males) had a mean age of 49.1 ± 14.2 years. Thirteen and 27 patients were cannulated with the rope-ladder and buttonhole techniques, respectively. Patients who underwent the buttonhole technique had more initial pain than did those who received the rope-ladder technique (p = 0.044). The BioholeTM procedure improved puncture pain (5.6 vs. 3.4, p = 0.003) and shortened hemostasis time (1.8 vs. 1.3, p = 0.001). Over a two-week period, patients using BioholeTM experienced dislocation (20.8%), bleeding at peg sites (8.6%), and pain during peg change (2.4%). Over the 12 week study period, patients who underwent the buttonhole technique had insignificantly less pain than did those who received the rope-ladder technique (p = 0.088), but the former had less bleeding time than the latter (p = 0.000). One patient who received the buttonhole technique experienced one episode of infection (p = 0.327). Conclusions:The new buttonhole technique using BioholeTM is safe and useful in the short term. A long-term, larger, multicenter study is required to confirm these results. (Korean J Med 2012;82:307-312)
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