锁骨下静脉置管在血液透析中应用分析

目的：探讨临时锁骨下静脉置管的安全性。方法：回顾分析1992年1月～2010年10月,经锁骨下静脉置管、进行血液透析之尿毒症患者的导管相关性并发症的发生率。结果：927例患者共行965次临时锁骨下静脉置管。一次置管成功率95.1%,换位后100%成功。导管留置共39860导管天,平均（45±12.57）d。发生急性并发症11例次,发生率1.14%。出口感染67例次,菌血症73例次,发生率各为1.68次及1.83次/1000导管天;无导管隧道感染;症状性深静脉梗阻42例次,发生率4.35%。结论：锁骨下静脉置管可替代颈内静脉作为血液透析临时通路,今后还需要大样本多中心临床对照研究来证实。

Retrospective Analysis of the Safety About Subclavian Vein Catheter as Blood Access for Hemodialysis

Objective：To evaluate the safety of subclavian vein catheter for hemodialysis.Methods：The incidence rates of catheter-related complications of uremic patients undergone catheter implantation via subclavian vein for hemodialysis access from January 1992 to October 2010 were analysed retrospectively.Results：927 patients who received 965 catheter implantations via subclavian vein were candidates.The implantation process success rate was 95.1%,but became 100% when puncturing the other subclavian vein of the unsuccessful patients for catheter implantation.The placement duration was 39860 catheter days in all,with mean value 45±12.57 days.11 urgent complications（1.14%）arose.67 cases of exit infection and 73 cases of bacteriacemia,which incidence rates were 1.68 and 1.83 per 1 000 catheter days respectively,happened during implantation.Meanwhile,none of subcutaneous tunnel infection occurred.42 cases（4.53%）of symptomatic subclavian vein thrombosis happened.Conclusion：Subclavian vein catheter for hemodialysis may be a possible alternative pathway for hemodialysis treatment.A multicenter prospective study for the safety and cost-effective value should be performed in the future.