血液透析患者不同途径置入中心静脉导管并发症的对比研究

目的 比较血液透析患者经颈内静脉穿刺置入中心静脉导管(jgular catheter,JC)与股静脉穿刺置入中心静脉导管(femoral catheter,FC)发生并发症,尤其导管源性感染(catheter related bacteremia,CRB)的情况.方法 经颈内静脉穿刺组(JC组,n=66)、经股静脉穿刺 (FC组,n=35).观察两组患者早期和晚期并发症.结果 早期并发症包括穿刺点出血、血肿形成和穿入动脉,两组比较差异无统计学意义.晚期并发症主要为CRB,两组CRB发生率各为27%、48%,相差有统计学意义,P＜0.001.JC、FC组28d生存率各为77.2%、51.4%,两组相比差异有统计学意义,P＜0.001.金葡萄菌感染是CRB最常见感染细菌.结论 JC操作方法简单,CRB等并发症发生率较低,导管留置时间较长,可作为临床上首选方法.

A comparative study on central venous catheters related infection via different accesses in hemodialysis

Objective To compare the incidence of complications associated with placement of jugular calheter(JC) and femoral catheters(FC) for hemodialysis,as well as to detect factors of predictive value for catheter survival and outcome.One of the most important complications is catheter related bacteremia(CRB).Methodols One hundred and one consecutive patients who required a temporary hemodialysis catheter were prospectively examined.Results Catheters were placed in 101 consecutive patients(right JC:66 cases,right FC:35 cases).Early complications(puncture site hemorrhage,hematoma formation,artery puncture) were infrequent without clinical sequelae.There was no statistical significance in early complications episodes.The main late complication was CRB.The incidence of CRB was found lower in JC groups(27%) than that in FC groups(48%),P<0.001.Actuarial survival for JC was significantly longer than for FC,P<0.001.Staphylococcus aureus was the most frequently isolated cause of CRB.Conclusion CRB is the most common late complication. Its frequency is significant in JC and FC.JC is easier to perform with lower incidence of CRB,and therefore is warranted to be used more widely in clinical practice.