颈外静脉切开置入带涤纶套中央静脉导管在特殊患者中的临床应用

目的 探讨颈外静脉切开置入带涤纶套中央静脉导管在特殊患者中的临床应用效果及评估其安全性.方法 将42慢性肾脏病（chronic kidney disease,CDK）5期并欲行带涤纶套中央静脉导管置入术的患者设为A组,以颈外静脉切开方法置管;同期选取36例已行右颈内静脉置入术的患者设为B组,置管方法为经皮穿刺右颈内静脉经撕脱鞘置入带涤纶套中央静脉导.观察术中、术后并发症.记录透析前后血肌酐、尿素氮变化以及透析中血流量、回血静脉压指标,计算尿素清除指数（Kt/V）值并比较.A组42例患者行颈外静脉切开置管患者根据原发病：糖尿病肾脏疾病、Ⅱ型心肾综合征进展至终末期肾脏疾病（end stage renal disease,ESRD）、慢性肾小球肾炎、强直性脊柱炎肾损害进展至终末期肾脏疾病、急性肾损伤,比较导管留存时间、导管中位留存时间.结果 2组患者Kt/V值均达标,血流量、回血静脉压无统计学差异（P＞0.05）,且透析前后血肌酐、尿素氮水平变化存在统计学差异（P＜0.05）.2组手术后未出现出血、血流量不佳导管相关性血流感染等并发症.A组中心肾综合征及急性肾损伤（acute kidney injury,AKI）患者导管留存时间与糖尿病肾脏疾病相比存在统计学差异（P＜0.05）.结论 尽管带涤纶套中央静脉导管置入方法推荐首选经典撕脱鞘置管,该方法安全成功率高,术后并发症少,但是经颈外静脉切开置入带涤纶套中央静脉导管术式在特殊患者中的临床应用中手术安全,能够保证透析充分性,并发症少,临床值得推荐.

Clinical application of external jugular vein incision for implanting cuffed central venous catheter in special patients

Objective To observe the clinical application and safety of external jugular vein incision for implanting cuffed central venous catheter in the special patients.Methods Forty-two patients undergoing external jugular vein incision for implanting cuffed central venous catheters served as group A,and 36 patients undergoing the classical avulsed sheath catheterization as group B.Complications were observed intraoperatively and postoperatively.Creatinine,urea nitrogen change and dialysis blood flow,blood return venous pressure index,and urea clearance index （Kt/V） values were recorded before and after dialysis and compared.Catheter retention time and the median retention time in group A were compared in terms of the primary diseases：diabetic nephropathy,type Ⅱ cardiorenal syndrome progression to end stage renal disease,chronic glomerulonephritis,ankylosing spondylitis kidney damage progression to end stage renal disease,and acute kidney injury.Results Kt/V was standardized in two groups.Blood flow and blood return venous pressure in groups A and B showed no significant difference,and there was significant difference in creatinine,urea nitrogen level before and after dialysis.The complications such as bleeding,poor blood flow and catheter related blood stream infection in two groups were not found after the operation.In group A,there was statistically significant difference in catheter retention time between type Ⅱ cardiorenal syndrome or acute renal injury and diabetic nephropathy.Conclusions Although the cuffed central venous catheter insertion method was recommended preferred classical operation,and the method was safe and high success rate,fewer complications,but the operation of by external jugular vein incision for implanting the cuffed central venous catheter was safe in special patients used in clinical practice,and could ensure the adequacy of dialysis with less complications.The operation was as clinical recommended.