1500例临时静脉留置导管透析的临床分析

目的探讨临时静脉内留置导管透析的血管选择、透析效果、并发症、影响因素及处理。方法静脉置管后观察导管血流量、留置时间、尿素清除指数（Kt／V）、再循环、血液流变学指标、并发症及其影响因素。结果颈内静脉、锁骨下静脉、股静脉是留置导管静脉常选静脉。1500例静脉留置导管总体使用良好，透析充分，Kt／V平均1．20±0．35；导管再循环率低为（10．5±2．5）％；留置导管常见的并发症依次为血流量不足、栓塞、感染、导管脱落等。大多数能通过调整导管位置、导管内溶栓及抗感染等处理改善；5例反复发生栓塞者血纤维蛋白原显著升高；导管尖端位于右心房者与上腔静脉者比较，前者具有更好的血流量、再循环率低[（285±50．5）ml／minVS（205±45．5）ml／mim（8±3．5）％VS（12±4．5）％，（P〈0．05）]；导管腔内高浓度肝素与低浓度肝素比较，前者导管留置时间明显延长（P〈0．05），检塞发生率减少（P〈0．05）。结论临时静脉内留置导管透析血流量充分，透析疗效确切。留置导管常见的并发症有血流量不足、栓塞、感染等，绝大多数能通过处理矫正。导管尖端位置、导管腔肝素浓度、血液粘度等对导管成活、血流量不足、栓塞有重要影响。

Clinical study of 1 500 temporary indwelling catheters in hemodialysis

Objective To investigate the use of temporary indwelling catheter in hemodialysis and evaluate vein choice, efficiency, complications and its factors. Methods 1 500 patients received internal vein catheter cannulation. The following indices were evaluated： blood flow, indwelling time, Kt/V, access recirculation and complications and its factors. Results Internal jugular veins, subclavi an, and femoral access were chosed for temporary vascular access for hemodialysis, the overall out- come of 1 500 catheters was good. Mean Kt/V was about 1.2 and access recirculation is 10%. The common complications of catheters included insufficient blood flow, thrombosis, infections, which can be treated by reversed arterial-venous line, urokinase, antinfection , respectively; 5 cases with repeated thrombosis have a significantly high level of fibrinogen; Better blood flow and smaller recirculation have been seen in the group of catheter tip in right atrium than the group in superior vena cava; High concentration of heparin in indwelling catheter cave can decrease the occurrence rate of thrombo- sis and prolong catheter survival. Conclusions Hemodialysis with the indwelling catheter is a safe, effective method. The complications are poor blood flow, thrombosis and infections and can be treated effectively. The position of the catheter tip, heparin concentration in catheter lumen and blood fibrinogen level have an important effect on catheter survival.