240例血液透析患者中心静脉置管的并发症及其处理

目的：分析血液透析患者中心静脉置管的并发症及其处理，探讨其临床意义。方法：回顾性分析240例血液透析患者的中心静脉置管，其中颈内静脉110例，股静脉116例，锁骨下静脉5例，永久性颈内静脉置管9例。结果：股静脉置管的导管感染发生率较颈内静脉置管明显高(P＜0．05)，肝素 抗生素封管，2例配合静脉滴注抗生素治疗，使导管感染得到完全控制。采用穿刺部位不切开皮肤直接扩皮置入导管，熟练仔细操作可明显降低局部渗血和血肿的发生率。以尿激酶封管治疗导管梗阻效果明显。结论：颈内静脉置管和永久性颈内静脉置管安全、可靠、并发症少，是血液透析患者较理想的血管通路。肝素 抗生素封管或配合全身抗感治疗中心静脉留置手管感染的方法，经济、有效，值得临床推广使用。

Complications of the Central Vein Catheter and the Treatment for Complications in 240 Hemodialysis Patients

Objective: To analysis the complications resulting from the central vein catheterization as well as the treatment of the complications in hemodialysis patients in order to evaluate the clinical importance of them.Methods: The cases of central vein catheter were retrospectively analyzed in 240 hemodialysis patients, in which 110 internal jugular vein, 116 femoral vein, 5 subclavian vein and 9 permanent internal vein catheter were involved. Results: The rate of the femoral vein catheter infection was significantly higher than that of the internal jugular vein ( P< 0.05), but no significant difference in the rates of hemorrhage and catheter obstruction was found between the femoral and internal jugular vein catheter. All cases of catheter infection were completely controlled by the management of catheter impregnation with haperin and antibiotics, in which two cases were treated with systemic antibiotics injection. By dilating the skin without incising the skin at the puncture site before inserting the catheter into the central vein, and with skillful and careful operation, the rates of the local blood seepage and hematoma could be reduced. The effect of catheter impregnation with urokinase to treat the catheter obstruction was certain. Conclusion:The internal jugular and permanent internal jugular catheter placement, being safe,reliable and revealing fewer complications ,are the ideal vascular access in hemodialysis patients. The method that the catheter impregnated with heparin and antibiotics, some treated with systemic antibiotics injection, to treat the catheter infection is economic and effective, and valuable in clinical application.