透视下与非透视下颈内静脉长期血液透析导管置管的临床效果观察

目的探讨在透视下与非透视下行颈内静脉长期血液透析（血透）导管置管术的临床效果。方法对2009年7月至2013年7月该院收治的88例尿毒症患者行颈内静脉长期血透导管置管术。前2年，42例均在导管室X射线透视定位下进行，右侧颈内静脉32例（A组），左侧颈内静脉10例（B组）；后2年，46例均为非透视下进行．右侧颈内静脉34例（C组），左侧颈内静脉12例（D组），观察置管的成功率、导管首次透析血流量、尿素下降率（URR）、整体尿素清除率（Kt／v）及性价比。结果四组均能成功置管，A组、C组导管首次透析血流量及充分性均良好，但A、C两组比较，差异无统计学意义（P〉0．05）；D组较B组置管首次透析血流量及充分性均差，差异有统计学意义（P〈0．05）。结论右侧颈内静脉置管术首选非透视下进行，在节约患者医疗费用的同时减少患者及医务人员的放射性接触；左侧颈内静脉置管可优先选用透视下进行．有利于及时确定导管尖端位置并予以调整．避免透析血流量不足及透析不充分．

Clinical observation of long-term indwelling catheter of hematodialysis in jugular vein under fluoroscopy and non-fluo-roscopy

Objective To investigate the clinical effects of long-term indwelling catheter of hematodialysis in jugular vein under fluoroscopy and non-fluoroscopy. Methods Totally 88 uremia patients,who were received from June 2009 to June 2013 were with long-term indwelling catheter of bematodialysis in jugular. In the first 2 years ,42 patients operated with fluoroscopy in conduit room, including 32 cases of right internal jugular vein （group A ） and 10 cases of left internal jugular vein （group B） ; in the last 2 years, the other 46 patients operated without fluoroscopy,including 34 cases of right internal jugular vein （group C ） and 12 cases of left internal jugular vein （group D ）. To observe the success rate, catheter blood flow volume of the first dialysis, urea reduction ratio（URR） ,the total urea clearance （Kt/v） and cost performance. Results The placement of permanent hemodialysis catheter were suecessful in all the 4 groups. The catheter blood flow volume of first dialysis and sufficiency were good enough in both group A and C, but the differenee between the two groups had no statistical signifieanee （P〉0.05） ;the catheter blood flow vol- ume of first dialysis and sufficiency in group D was worse than those in group B with statistically signifieant differenee （P〈0.05）. Conclusion Non-fluoroscopy is the first choiee for indwelling eatheter in right internal jugular vein ,which can save medical ex- penses and reduce the radioactive contact of patients and medical workers ;fluoroscopy is the first choiee for indwelling catheter in left internal jugular vein, it is eonducive to determine the loeation of eatheter tip and adjust the location timely to avoid insuffieient blood flow volume of dialysis and inadequate dialysis.