中国血液净化

›› 2005, Vol. 4 ›› Issue (3): 142-145.

• 论著 • 上一篇    下一篇

190例次涤纶环深静脉留置导管应用回顾性分析

叶朝阳 张玉强 张黎明 戎 殳 陈 静 马晓红 张 斌 梅长林   

  1. 200003 上海，第二军医大学附属长征医院 解放军肾病中心
  • 收稿日期:1900-01-01 修回日期:1900-01-01 出版日期:2005-03-12 发布日期:2005-03-12

  • Received:1900-01-01 Revised:1900-01-01 Online:2005-03-12 Published:2005-03-12

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摘要：

目的 探讨涤纶环深静脉留置导管血液透析的使用和退出原因，提高置管成功率。方法 分 析置管方法与血流通畅情况、随访留置导管的使用和并发症，记录导管使用终点。结果 ① 实施深静脉留置长期带涤纶环导管术190例次（193根导管），其中12例次为再次置管；经颈内静脉入路149例次，成功率97%，经锁骨下静脉30例次，成功率96%，经颈外静脉切开插管13例次（成功率81%），上腔静脉置管成功率99.5%，1例经股静脉；② 导管使用期限：平均(14.3±10.5)个月，使用留置导管时间分别为：>84月1例，>48月4例，>36月5例，≥24月25例，≥12月54例次，≥6个月38例次，40例次<6个月（大部分在继续使用），23例失访。观察导管使用终点96例次，约占50.5%，导管退出时平均使用时间(9.8±7.5)个月(3～46)月；退出原因：死亡67例，其余为感染拔管、导管拔脱、血流不畅和肾移植。在导管使用终点，91.7%（88/96）的导管功能良好；③ 导管透析充分性：114例患者的透析后尿素下降率平均70%，平均Kt/V达到1.55。与内瘘透析患者Kt/V=(1.50±0.33)(n=30)比较差异无显著性；④右颈内和右锁骨下置管效果相似，左侧颈内和左锁骨下置管血流不畅发生率高；⑤ 感染40例次，平均感染率1.78次/患者年；治疗有效29例次，无效拔管11例次。感染病原：金黄色葡萄球菌、绿脓杆菌、表皮葡萄球菌、醋酸不动杆菌、霉菌等，本院感染率低于外院。结论 长期导管使用人群主要是老年人和多次内瘘失败者，长期导管可以达到充分透析，良好的导管留置技术提高导管的有效使用，尽量采用右侧颈内和锁骨下置管，良好护理显著降低导管感染率。

关键词: 血液透析, 涤纶环双腔导管, 透析充分性

Abstract:

Objective To analyze the causes of using tunnel cuffed catheters and its using end-point. Methods The patency of catheters and their complications were observed. The end-points of catheters were recorded. Results The dual lumen cuffed catheters were implanted in 178 cases (193 times) of chronic renal failure (CRF) patients. The catheters were re-implanted in 12 patients. One hundered and forty-nine catheters were implanted in the internal jugular vein, 30 catheters in the subclavian vein and 13 catheters in the external jugular vein; The using period were as follow,there were 1 case longer than 84 months, 4 cases longer than 48 months, 5 cases longer than 36 months, 25 cases longer than or equal to 24 months, 54 cases longer than or equal to 12 months, 38 cases longer than or equal to 6 months and 40 cases shorter than 6 months（14.3±10.5 months inaverage）. Ninely-six cases were followed up until the end-point of the investigation. At the endpoint, the catheters had been used for 3 months to 46 months (9.8 months inaverage), and exit causes were death, infection, pull-out, dysfunction and renal transplantation; Dialysis adequacy: the average Kt/V was 1.55, URR was 0.7 in 114 cuffed catheter cases, which had no difference with that of patients using arterio-venous fistula(Kt/V=1.50±0.33, n=30); ④ The function of catheters in right internal jugular vein was similar to that in right subclavian vein. The dysfunction of catheters in left internal jugular or subclavian vein happened more often than that in right vein; ⑤ Infection occurred for 40 times: average infectious rate was 1.78 episodes/patient-year, 29 cases were cured, 11 failed to be controlled. The infectious bacteria were aerococcus staphylococcus aureus, staphylococcus epidermidis, bacillus pyocyaneus and fungus. Conclusion The cuffed catheters are mainly used for the elderly patients and those who failed to create AVF. The patients could get adequate dialysis by cuffed catheters hemodialysis. Good catheter planting technique is important for effective useing of catheter and reducing infection. The catheters should be implanted in the right internal jugular or right subclavian vein for the good function.

Key words: Cuffed catheter, Complication

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