深静脉置管行血液净化治疗临床病例分析

张涤华; 郑智华; 许元文; 李广然; 郑勋华; 黄锋先; 吴培根; 沈清瑞; 余学清

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中国血液净化 ›› 2006, Vol. 5 ›› Issue (2) : 72-74.

论著

深静脉置管行血液净化治疗临床病例分析

张涤华郑智华许元文李广然郑勋华黄锋先吴培根沈清瑞余学清

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摘要

目的总结血液净化治疗患者留置临时性中心静脉导管的经验, 探讨中心静脉留置导管在血液净化治疗中的应用以及中心静脉留置导管并发症的防治。方法 2004年2月～2005年6月,中山大学附属第一医院肾内科行临时性单针双腔静脉导管留置术血液净化治疗病例223例,其中颈内静脉置管193例（右181例，左12例），右锁骨下静脉置管21例，股静脉置管9例（右8例，左1例）。分析不同置管方法临床并发症的发生率及处理方法。结果置管术中的常见并发症有:误穿动脉8例(3.6%),皮下血肿10例(4.5%),穿刺部位渗血3例(1.3%)。置管术常见远期并发症有：导管相关感染28例(12.6%),导管栓塞9例(4.0%)，导管意外脱落5例(2.2%),血流量不足(血流＜180ml/min)21例(9.0%)。带管时间3～155天。结论临时性中心静脉留置导管是建立血液净化治疗血管通路的一种方便快捷方法, 操作技术简便,并发症低,并能提供稳定血流量,是建立血液净化治疗临时性血液通路的理想选择。

Abstract

Objective To review the clinical applications, complications and its managment of central venous catheterizations in patients undergoing blood purification therapy. Methods A retrospective study was performed in 223 cases of patients undergoing blood purification therapy with central venous catheters during February , 2004 to June, 2005, which include 193 internal jugular venous catheterizations (181 on the right side,12 on the left side), 21 subclavian venous catheterizations and 9 femoral venous catheterizations (8 on the right side,1 on the left side). The complications and their management were analyzed. Results The common acute complications of catheterizations included inadvertent arterial puncture in 8 cases (3.6%), local hematoma in 10 cases (4.5%) and local bleeding in 3 cases(1.3%). The common long-term complications of catheterizations included infection in 28 cases(12.6%), catheter obstruction in 9 cases(4.0%), catheter inadvertent withdrawal in 5 cases (2.2%) and catheter inadequate blood flow(＜180ml/min) in 21 cases(9.4%). The catheter was kept for 3 to 155 days. Conclusion Central venous catheterization is a convenient and easy way to set up a vascular access for blood purification therapy and it has a low rate of complications which can be controlled easily and safely.