长期留置导管在血液透析中的应用效果观察

目的总结和探讨长期颈内静脉留置带涤纶环双腔导管后的应用效果及维护。方法选取贵州省人民医院肾内科2010年10月-2012年4月长期留置导管术的65例血液净化患者,术前均行颈内静脉B超,颈内静脉在7 mm以上入组。入组后采用Seldinger技术穿刺颈内静脉并置入Cuff管,右侧60例,左侧5例。留置双腔导管通过撕脱鞘或引导导丝送入颈内静脉血管。结果 65例患者中,置管总成功率为94%,留置导管最长时间达22个月,平均导管留置时间为10.5个月。手术1周内常见并发症：导管由撕脱鞘送入组隧道局部出血的发生率明显高于导管直接由导丝送入组,导管位置功能不良的发生率明显低于导管直接由导丝送入组,差异有统计学意义（P〈0.05）;其他并发症,如气胸、血气胸和导管内血栓形成,两组比较,差异无统计学意义（P〉0.05）,提示气胸、血气胸和导管内血栓形成可能与导管的置入方式无关。结论长期深静脉置管操作安全,简便,并发症少,能达到满意的透析效果,使用时间长,形成血栓及栓塞率低,感染率低,可满足血管条件差的、不能行自体动静脉内瘘的患者。

Application effect observation of long-term indwelling catheters in hemodialysis

Objective To discuss the application effect of long-term indwelling catheter with double polyester cavities in hemodialysis. Methods 65 cases of patients with hemodialysis treated in the Department of Nephrology of Guizhou People′s Hospital from October 2010 to April 2012 were selected.B ultrasound internal jugular vein was carried out before operation,internal jugular vein was more than 7 mm were considered in group.Seldinger technique was used to puncture the internal jugular vein and placed Cuff tube,60 cases in right side and 5 cases in left side.The catheteres were indwelled in tibial vein through Avulsed sheath or the wire-guide technique. Results The success rate in indwelling catheter was 94% among 65 cases.The average indwelling catheter time was 10.5 months and the longest one reached 22 moths.The common complications in 1 week surgery： the incidence of local bleeding in the catheter sent by avulsion sheath group was higher than that in the catheter directly sent by guide wire group,the incidence of catheter position function adverse was lower than that in the catheter directly sent by guide wire group,the difference was significant（P〈0.05）;other complications,such as pneumothorax,hemopneumothorax and catheter thrombosis,there was no significant difference between the two groups（P〉0.05）,prompted that,pneumothorax,pneumothorax and catheter thrombosis may be unrelated with catheter placement way. Conclusion The long-term indwelling catheter is simple and safe in operating with few complications,which can achieve satisfactory hemodialysis effect,can use for a long time,thrombosis and embolism is low,the infection rate is low.The catheter is appropriate for the patient with difficult establishment of internal arteriovenous fistula due to many kinds of reasons.