中国血液净化

中国血液净化 ›› 2021, Vol. 20 ›› Issue (09): 628-631.doi: 10.3969/j.issn.1671-4091.2021.09.013

• 血管通路 • 上一篇    下一篇

库克经皮导入器在右无名静脉闭塞的血液透析患者中再置隧道式透析导管的应用

刘丽1,2,陈勤1,沈茜1,崔天蕾1   

  1. 1四川大学华西医院肾脏内科
    2四川省林业中心医院肾脏内科

  • 收稿日期:2021-04-13 修回日期:2021-05-25 出版日期:2021-09-12 发布日期:2021-09-12
  • 通讯作者: 崔天蕾 52522168@qq.com E-mail:tianleicui@163.com
  • 基金资助:
    四川省卫生厅科研基金(140063)

Dialysis catheter replacement in patients with occluded right innominate by Nelf Percutaneous Acces Set#br#

  1. 1Department of Nephrology, West China Hospital, Sichuan University, Chendu 610041, China;  2Department of Nephrology, Sichuan Province Forestry Center Hospital, Chendu 610041, China
  • Received:2021-04-13 Revised:2021-05-25 Online:2021-09-12 Published:2021-09-12
  • Contact: Tianlei Cui Tianlei Cui E-mail:tianleicui@163.com

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摘要： 【摘要】目的评估库克经皮导入器对右无名静脉或双侧无名静脉闭塞的患者进行经皮穿刺置入隧道式透析导管的可行性和安全性。方法回顾性分析2018 年4 月～2019 年8 月四川大学华西医院所有通过库克经皮导入器经皮穿刺置入隧道式透析导管的右/双侧无名静脉闭塞的患者。在X 光引导下，将该套件中的穿刺针朝着放置在上腔静脉中心侧的血管造影导管推进，随后交换导丝放置隧道式透析导管。评估手术成功率、导管通畅率和并发症发生率。结果所有35 例患者手术均取得成功。在随访期间[10(6，20)m]，有2 名患者出现导管功能障碍，1 名患者死于心血管事件，其余的患者导管功能均良好直到随访期结束。手术中没有发生置管相关的严重并发症或死亡。最常见的并发症是纵隔血肿(n=3)，其中最大血肿的直径为1.8cm，均自行消退。结论对于中心静脉或常规置管部位闭塞的患者，库克经皮导入器可以安全地经皮放置隧道式透析导管。

关键词: 血液透析通路, 中心静脉置管, 无名静脉闭塞, 血管通路耗竭

Abstract: 【Abstract】Objective The purpose of this study was to assess the feasibility and safety of placement of tunneled cuffed catheters by Nelf Percutaneous Acces Set in patients with occluded right and left innominate veins. Method It was a retrospective review of the use of Nelf Percutaneous Acces Set in tunneled catheter placement in patients with right and left innominate vein occlusions between April 2018 and August 2019. In all cases, the puncture needle was directed and advanced toward the angiographic catheter placed on the central side of the superior vena cava under fluoroscopic guidance. And then exchanged the guidewire and placed a tunneled central venous catheter. The outcome measures evaluated were technical success rate, catheter patency,
and complication rate. Results The procedure succeeded in all 35 patients. During follow-up [10 (6, 20) months], access failure was observed in two patients. The remained patients functioned well until the end of the follow-up period or until the death of the patient (n=1). No procedurErelated major complication occurred. The most common complication was mediastinal hematoma after puncture failure in three patients. The diameter of the maximum hematoma was 1.8 cm, and all resolved spontaneously. Conclusion In patients with exhaustion access, a tunneled central venous catheter can be safety placed by Nelf Percutaneous
Acces Set through the transcutaneous route.

Key words: Hemodialysis vascular access, Central venous catheterization, Occlusion of innominate vein, Exhausted access

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