111例长期深静脉留置透析导管患者相关并发症的分析

目的 通过分析111例长期深静脉留置透析导管患者相关并发症的临床资料,探讨其防治措施。方法 选择我院2001年1月～2003年3月新留置长期深静脉双腔透析导管使用时间大于6个月的患者111例,导管留置总时间为1090个患者月,平均已留置时间为9．8个月。所有导管均选用Quinton Permcath带cuff长期留置透析导管,插管部位首选右颈内静脉,其次为左颈内静脉、髂外静脉。出现导管并发症(感染、血栓等)予对症处理。结果 局部血肿的发生率为8．1％。导管位置不良的发生率为4．5％。111例患者中有6例发生导管感染,感染率为5．4％,2例为细菌感染,抗生素治疗有效;4例为真菌感染,1例治愈,3例拔管并重新置管。导管血栓形成的发生率为18、9％,发生血栓时导管平均留置时间为36d;20例患者尿激酶溶栓后导管恢复通畅,成功率为95．2％,其中18例再次发生导管血栓,5例患者加服血小板抑制剂后能保持导管长期通畅,13例仍多次发生血栓,改服华法林后,9例有效,另4例改建内瘘或移植血管。溶栓及联合抗凝治疗使16例患者的导管使用寿命平均延长了6个月。结论 深静脉双腔透析导管的留置和长期应用是安全有效的,导管血栓形成是其最为常见的并发症,溶栓及联合抗凝治疗可显著延长导管的使用寿命。

Complications related to permanent deep venous catheterization using dual lumen hemodialysis catheter

ObjectiveTo observe the incidence of long-term venous indwelling catheter related complications in hemodialysis patients and to report our clinical approach to the complications. MethodsA hundred eleven hemodialysis patients was prospectively studied from Jan. 2001 to Mar.2003, in whom the venous indwelling catheter had been in place for more than 6 months. Catheter related complications were observed over a total period of 1090 patients months, with a mean period of 9.8 months(6-27 months). ResultsThe incidence of hematoma was 8.1%(9/111),and that of catheter malposition was 4.5%.There was no hemothorax, pneumothorax, air embolism or veinous laceration. Six episodes of catheter related infection were observed during the observation, with an incidence of 5.4%; two cases with bacterial infection were successfully treated; while among the 4 cases with fungal infection, one was successfully treated and catheters were removed in other 3 cases for uncontrolled infection. The incidence of catheter thrombosis was 18.9%(21/111) and the catheter had been used for a mean period of 36 days(6-725 days)from placement to thrombosis. Catheter patency was restored in 95.2% (20/21) by urokinase infusion. Recurrent thrombosis occurred in 18 of 20 catheters (90.0%), of which 5 worked functionally following anti-platelet therapy and 13 had recurrent thrombosis. Following anticoagulation by warfarin, 9 became functional(69.2%),but the other 4 cases turned to other vascular access. Urokinase infusion followed by anticoagulation had prolonged the mean catheter life-time for 6 months(3-18 months). ConclusionCuffed dual lumen catheter as permanent access is safe and effective. Catheter thrombosis is the most common complication. Urokinase infusion followed by anticoagulation can significantly prolong the catheter life-time.