69例临时中心静脉透析导管患者的临床分析

目的通过分析69例临时中心静脉置管血液透析患者的相关临床资料，探讨其临床运用的优缺点。 方法选择常州市武进人民医院血液净化中心2017年1月至12月新留置临时中心静脉导管进行血液透析的69例患者为研究对象，进行回顾性病例分析研究，其中男性42例，女性27例；年龄20～89岁，平均(61.06±15.09)岁。统计并记录69例患者的原发疾病、导管留置部位与时间、导管相关性感染以及导管血栓形成情况、疾病转归。对比分析不同的置管部位对血液透析治疗效果和安全性的影响。 结果69例临时中心静脉置管患者的原发疾病主要为慢性肾炎30例(43.48%)、肿瘤相关性肾病12例(17.39%)、糖尿病肾病9例(13.04%)等，直接直观原因包括急性肾衰竭17例(24.63%)、慢性肾衰竭首次透析内瘘未成熟43例(62.32%)以及内瘘失功9例(13.04%)。14例(20.29%)患者死亡、7例(10.14%)患者好转、33例(47.83%)转为长期血液透析、5例(7.25%)转为腹膜透析、1例(1.45%)患者放弃治疗。4例(5.79%)患者出现了导管相关性感染，感染率为1.47次/1 000导管日；12例(17.39%)患者发生血栓形成，其中3例(25.00%)溶栓无效，重新置管，余9例(75.00%)患者经溶栓治疗可维持适当的血流量，9例溶栓患者的平均溶栓次数为(3.44±1.84)次。69例临时中心静脉置管血液透析患者中，选择颈内静脉和股静脉的患者分别为39例(56.52%)和30例(43.48%)，不同部位导管的留置时间无差异(39.64±25.43)比(38.86±26.77)d，P>0.05]，但颈内静脉置管的导管相关性感染率(0.65次/1 000导管日比2.57次/1 000导管日)和血栓形成率5.13%(2/39)比33.33%(10/30)，P<0.05]均低于股静脉置管。 结论临时中心静脉置管为透析患者第一时间建立了安全、快捷、可靠的临时血管通路，在临床运用中值得推广；但临时中心静脉透析导管也增加了透析患者的感染率及血栓形成率。

Clinical analysis of 69 patients with temporary central venous dialysis catheter

ObjectiveThe clinical data of 69 patients with temporary central venous catheterization hemodialysis were analyzed and the advantage and disadvantage of clinical application were discussed. MethodsFrom January to December 2017, 69 patients were selected from the blood purification center of Wujin people’s Hospital of Changzhou City for hemodialysis. Among them, 42 cases were males and 27 cases were females. The average age was (61.06 ±15.09) years. The primary diseases, the location and time of catheter indwelling, the incidence of ductal thrombus and the incidence of ductal thrombus were recorded in 69 patients. The effects of different catheterization sites on the efficacy and safety of hemodialysis were comparatively analyzed. ResultsThe primary diseases of 69 patients with temporary central venous catheterization were chronic glomerulonephritis (n=30), tumor associated nephropathy (n=12) and diabetic nephropathy (n=9). The direct cause included 17 cases of acute renal failure, 43 cases of immature internal fistula for the first time dialysis of chronic renal failure, 9 cases of failure of internal fistula. The prognosis of disease included 14cases 7 cases of improvement and 33 cases of chronic hemodialysis, 5 cases of chronic hemodialysis. One patient with peritoneal dialysis (1.45%) gave up treatment. 4 cases (5.79%) developed catheter-related infection. The infection rate was 1.47/1 000. Thrombosis occurred in 12 patients (17.39%), 3 of them (25.00%) had no effect of thrombolysis, and catheterization was re-inserted. The remaining 9 patients (75.00%) were treated with thrombolysis to maintain adequate blood flow. The average number of thrombolysis was (3.44±1.84) times. Among 69 hemodialysis patients with temporary central venous catheters, 39 patients (56.52%) chose internal jugular vein and 30 patients (43.48%) chose femoral vein, respectively. There was no difference in catheter placement time between different sites (39.64±25.43) d ratio (38.86±26.77) d, P>0.05], but catheter-related infection rates of internal jugular vein catheters (0.65 times/1 000 catheter days vs 2.57/1 000 catheter days) and thrombosis rate 5.13% (2/39)vs 33.33%(10/30), P<0.05]was lower than that of femoral vein. ConclusionTemporary central venous catheterization is a safe, fast and reliable temporary vascular access for dialysis patients, which is worth popularizing in clinical application, but it also increases the infection rate and thrombosis rate of dialysis patients.