两种深静脉置管方式在血液透析中的临床应用

目的探讨寻找安全有效的血液透析中心静脉置管方式。方法回顾性分析我院245例中心静脉置管术，颈内静脉置管171例，股静脉置管74例，其中盲穿置管169例，彩超定点引导穿刺置管76例。分析两种置管方式临床并发症的发生率及处理方法。结果盲穿患者近期并发症中误伤动脉6例（3．6％），局部血肿4例（2．4％），渗血3例（1．8％），误伤胸导管1例（0．6％），气胸1例（0．6％）。彩超定点引导下穿刺置管成功69例，未发生近期并发症。两种方式比较（P〈0．05）。结论彩超定点引导中心静脉置管是一种安全有效的方法，可在临床推广应用。

Clinical Application of Two kinds of Central Vein Catheterization in Hemodialysis

Objective To explore and find the safe and effective method of central vein catheterization for hemodialysis patients.Methods We analyzed 245 hemodialysis patients using central vein catheterization retrospectively.171 internal jugular venous catheterizations and 74 femoral venous catheterization were included in the study.Two methods were performed:blind catheterization in 169 cases and catheterization by color Doppler ultrasonography guidance in 76 cases.Complications and management of the two methods were analyzed with P<0.05.Results In the 169 cases using blind catheterization,complications included misplacement into arteries in 6(3.6%),local hematoma in 4(2.4%),local bleeding in 3(1.8%),misplacement into thoracic duct1(0.6%),pneumothorax in 1(0.6%).No complications were found in 76 cases by color Doppler ultrasonography guidance.Conclusion Catheterization by color Doppler ultrasonography guidance is a safe and effective method.