213例深静脉置管在血液净化治疗中的应用分析

目的总结中心静脉留置导管在血液净化治疗中的应用以及相关并发症防治的经验。方法回顾性分析2006年1月～2010年8月该院肾内科213例行临时性单针双腔静脉导管留置术进行血液净化治疗的临床病例,其中股静脉置管149例(右135例,左14例),颈内静脉置管61例(右59例,左2例),右颈外静脉置管2例,右锁骨下静脉置管1例。分析不同深静脉置管临床并发症的发生率和处理方法。结果误穿动脉12例(5.63%),皮下血肿1例(0.47%),穿刺部位渗血6例(2.82%),导管意外脱落2例(0.94%),导管栓塞15例(7.04%),导管相关感染17例(7.98%),血流量不足(血流<160 ml·min-1)24例(11.27%)。带管时间5～378 d。结论临时性中心静脉留置导管能为血液净化治疗建立血管通路提供一种快捷的方法,其操作简便,方式多样,并发症低且可防治,血流量能稳定提供,是建立临时性血管通路的理想选择。

Application of central venous catheterization of purification therapy in 213 cases

Aim To review clinical applications,complications and management of central venous catheterizations in patients undergoing blood purification therapy.Methods A retrospective study was performed in 213 cases of patients undergoing blood purification therapy with central venous catheters during January,2006 to August,2010,which included 149 femoral venous catheterizations（135 on the right side,14 on the left side）,61 internal jugular venous catheterizations（59 on the right side,2 on the left side）,2 external jugular venous catheterizations（on the right side） and 1 subclavian venous catheterization（on the right side）.The complications and their management were analyzed.Results There were inadvertent arterial puncture in 12 cases（5.63%）,local hematoma in 1 case（0.47%）,local bleeding in 6 cases（2.82%）,catheter inadvertent withdrawal in 2 cases（0.94%）,catheter obstruction in 15 cases（7.04%）,catheter-related infection in 17 cases（7.98%）,catheter inadequate blood flow（160 ml·min^-1） in 24 cases（11.27%）.The catheter was kept for 5 to 378 days.Conclusion Central venous catheterization is a convenient and easy way to set up a vascular access for blood purification therapy and it has a low rate of complications which can be controlled easily and safely.