利用导丝经临时静脉导管置入涤纶环导管的临床评价

目的评价利用导丝经右颈内静脉临时导管置入涤纶环导管在维持性血液透析中的应用价值。方法观察22例次利用导丝经右颈内静脉临时导管置入涤纶环导管（A组）和24例次新穿刺右颈内静脉留置涤纶环导管（B组）的临床应用情况。结果A组和B组导管中位使用寿命分别为19、21个月，导管使用寿命生存曲线差异无统计学意义（χ^2=0．05，P=0．82）。A组和B组插管处皮肤感染的发生率分别为（O．13±0．01）、（0．15±0．02）次／100导管日，导管引起的全身感染发生率分别为（O．31±0．03）、（0．32±0．02）次／100导管日，组间比较差异无统计学意义；A组和B组插管时局部出血或血肿发生率40．91％（9／22）比45．83％（11／24）]、使用导管透析时血流量（230．53±28．27）ml／min比（238．71±25．94）ml／min]和导管血栓形成率31．82％（7／22）比33．33％（8／24）]比较，差异无统计学意义（P〉0．05）；两组均无纤维鞘形成和颈内静脉狭窄发生。结论利用导丝经右颈内静脉临时导管置入涤纶环导管可避免再次穿刺颈内静脉，同时不增加导管相关并发症，可作为留置涤纶环导管的一种方法。

Clinical evaluation on inserting haemodialysis cuffed catheter using guidewire through temporary catheter

Objective To evaluate the application of inserting haemodialysis cuffed catheter using guidewire through temporary catheter in maintenance haemedialysis. Methods Compared with 24 cuffed catheter inserted by puncturation of right internal jugular vein （B group）, application of 22 cuffed catheter inserted by guidewire through temporary catheter in right internal jugular vein （A group） were observed. Results Median survival time was 19 months in A group and 21 months in B group. There was no significant difference in survival curve between A group and B group （ χ^2 = 0.05, P = 0.82 ）. Compared with those in B group, the incidence of local infection （0.13 ± 0.01 ） per 100 catheter days vs （0.15 ±0.02 ） per 100 catheter days], systemic infection （0.31 ± 0.03） per 100 catheter days vs （0.32 ±0.02） per 100 catheter days], errhysis or haematoma in catheter 40.91% （9/22） vs 45.83% （11/24）], the blood flow in haemodialysis using catheter （230.53±28.27） ml/min vs （238.71 ±25.94） ml/min] and the thrombus in catheter 31.82%（7/22） vs 33.33%（8/24）]were no significant difference. And there were no occurrence of fibrous sheath and right internal jugular vein stenosis in both groups. Conclusion Inserting haemodialysis cuffed catheter in right internal jugular vein by using guidewire through temporary catheter is an alternative strategy, because of avoiding this avoids vein re-puncturation and doesn＇t increase catheter related complication.