两种长期留置导管置入方法在临床应用中的探讨

目的 比较撕脱鞘导入法与改良导丝引导法留置Palindrome导管的安全性及易用性.方法 选择2011年9月至2013年12月我院透析中心拟行Palindrome导管置管术的血液透析患者36例,按置管方法分为撕脱鞘导入组（撕脱鞘组）和改良导丝引导组（导丝组）,每组18例,辅以术前彩色多普勒超声定位,了解有无血栓形成以及血管狭窄等,并行血常规、凝血功能检查,如有凝血功能异常者在术前予以纠正.所有长期留置导管均在手术室完成,术中予以心电监护.收集2组患者基线资料,置管后观察24 h,主要终点为置管术中出血量,次要终点为整个置管术的操作时间和置管术后24 h置管伤口出血事件发生率.结果 撕脱鞘组共入组18例患者,导丝组共入组18例患者,2组基本一致.导丝组较撕脱鞘组在术中出血量[（4.0±2.1）ml vs （12.9±3.3）ml,P＜0.01]、置管时间[（26.3±3.2）min vs（34.4±3.0）min,P＜0.01]及术后24 h出血事件发生率（4.3％ vs 27.3％,P＜0.05）的差异均有统计学意义.同时在彩色多普勒超声定位下,导丝引导法留置导管,降低了误穿动脉、穿刺失败等多种并发症的发生.结论 辅以术前彩色多普勒超声定位,直接导丝导入法比撕脱鞘导入法显著减少术中出血量、置管时间及术后24 h出血事件发生率,提高了手术的安全性和成功率,值得在临床应用中推广.

Comparison of the two insertion methods for Palindrome catheter

Objective To explore the superiority of indwelling permanent jugular venous catheters for hemodialysis under modified steel wire guidance by comparing with the conventional avtdsion technique.Methods Thirty six patients with end stage renal disease （ESRD） accepting permanent jugular venous catheter indwelling in our dialysis center from September 2011 to December 2013were randomly allocated into two groups：modified steel-wire guidance （n =18,modified group）,and conventional seldinger technique （n =18,conventional group）.The bleeding volume,complications,success rate and therapeutic effect were compared between two groups.The patients who were arranged to use indwelling Palindrome dialysis catheter were enrolled and divided into two groups：pull-apart sheath method group （PAS group） and guide wire group （WG group）.Every patient was subjected to ultrasonography examination.Understand the presence of thrombosis,and vascular stenosis.Parallel routine blood,and clotting function,such as a coagulant function abnormality,preoperative corrected.All half a permanent internal jugular vein catheter are completed in the operating room,intraoperative to ecg monitoring.The general information of patients as well as the results of blood counts and blood coagulation tests was collected before the insertion.Prospective observation was carried out 24 h after the insertion.Results There were 18 patients in the PAS group and 18 patients in the GW group.The general information was basically similar between the two groups.As compared with the PAS group,the GW group had significantly less blood loss during insertion procedure （4.0 ± 2.1 mL vs.12.9 ±3.3 mL,P〈0.001）,shorter catheterization time （26.3 ± 3.2 min vs.34.4 ± 3.0 min,P〈0.001）,and lower incidence of wound bleeding event within 24 h after the insertion （4.3% vs.27.3%,P〈0.05）.Conclusions The insertion of Palindrome catheter by using guide wire can significantly reduce blood loss during insertion procedure,time spent for catheterization,and incidence of wound bleeding within 24 h after the insertion as compared with pull-apart sheath method.