长期留置深静脉导管相关并发症的防治

目的探讨长期留置深静脉导管在血液透析患者留置时相关并发症及其防治。方法选择广州军区广州总医院近3年来57例血液透析患者共64例次长期留置深静脉导管,分析出现的并发症并给予对症处理。结果导管平均留置时间（11.2±7.4）个月。术后出现局部血肿3例（4.7%）,出现隧道出血2例（3.1%）;因位置不佳术后即出现导管失功能2例（3.1%）,立即调整导管位置后血流量恢复正常。导管血栓形成14例（21.9%）,其中12例经尿激酶溶栓治疗后血流量恢复正常,溶栓成功率为85.7%;无效者2例给与拔管。导管内感染7例（10.9%）,其中细菌感染4例经抗生素治疗有效;真菌感染2例及未查到病原菌者1例治疗无效拔管。出口部位感染1例（1.6%）。结论长期留置深静脉导管是安全有效的,长期留置时可能出现导管血栓形成、导管内感染等并发症,积极预防和处理并发症能显著延长导管的使用时间。

Prevention and treatment of complications on patients dialysed through permanent indwelling catheters

Objective To discuss the complications of the permanent indwelling catheters in hemodialysis patients and the approach to their prevention and treatment.Methods The study included fifty-seven hemodialysis patients with sixty-four permanent indwelling catheters in the recent three years in Guangzhou General Hospital of Guangzhou Command of PLA.The complications of these catheterized patients were analyzed and treated.Results The average survival of the indwelling catheters was（11.2±7.4） months.Three cases of 64 catheters（4.7%） developed hematoma;two cases of them（3.1%） tunnel bleeding.Dysfunction of catheters occurred in two cases（3.1%） because of malposition,of which the catheters were adjusted immediately.Catheter thrombosis occurred in fourteen cases（21.9%）;the catheter patency was restored in twelve cases（85.7%） by urokinase infusion and two catheters without restoration were removed.Seven cases（10.9%） with catheter-related infection were observed;four cases with bacterial infection were successfully treated;but in two cases with fungal infection and one case with unknown microorganism infection,catheters were removed for uncontrolled infection.Catheter export infection occurred in one case（1.6%）.Conclusion Permanent indwelling catheter is safe and effective for hemodialysis patients.When the catheters are used,many complications might happen,such as catheter thrombosis and catheter-related infection,etc.Through preventing and handling the complications of permanent indwelling catheters,we can significantly prolong the catheter time of service.