›› 2009, Vol. 8 ›› Issue (6): 309-312.

• 论著 • 上一篇    下一篇

中心静脉留置导管在血液透析中的应用

符 晓 朱笑萍 吴 鸿 袁 芳 陈 星   

  1. 中南大学湘雅二医院肾内科
  • 收稿日期:2008-09-16 修回日期:1900-01-01 出版日期:2009-06-12 发布日期:2009-06-12
  • 通讯作者: 符晓

Application of indwelling central venous catheterization in hemodialysis

FU Xiao, ZHU Xiao-ping, WU Hong, YUAN Fang, CHEN Xing   

  1. Department of Nephrology, The Second Xiangya Hospital of Central South University, Changsha 410011, China
  • Received:2008-09-16 Revised:1900-01-01 Online:2009-06-12 Published:2009-06-12

摘要:

【摘要】目的 分析血液透析患者中心静脉置管的并发症和处理,总结其经验。方法 分析2005年1月~2007年9月中南大学湘雅二医院肾内科血液透析患者1251例,留置中心导管1269例次。其中,置入股静脉409例,颈外静脉544例,颈内静脉285例,永久性置管31例。结果 导管留置时间:股静脉平均3周,颈内、外静脉平均4月,永久性置管平均11月。置管过程中主要的并发症为误穿动脉(2.36%)、局部血肿(2.13%)和渗血(1.26%)。导管留置过程中的主要并发症为感染(6.38%)和导管流量不足(5.04%)。感染包括局部感染(6.38%)和导管感染(2.83%),股静脉置管者感染的发生率最高,分别为10.27%和3.67%,是股静脉留置时间最短的主要原因。颈内、外静脉留置导管感染率无明显差异。局部感染者每日消毒换药,导管感染者采用庆大霉素8万单位加尿激酶1万单位封管,封管2~3次症状缓解者继续封管2周,无效则拔管。导管流量不足原因有导管贴壁、打折或导管内血栓形成,以双腔导管多见。导管异位以颈外静脉置管者多见(2.57%),主要和颈外静脉的解剖位置有关。结论 中心静脉留置导管可作为血液透析患者理想的血管通路,但应注意其适应症,熟练掌握操作技术,预防和处理各种并发症。

关键词: 血液透析, 血管通路, 中心静脉置管, 并发症

Abstract:

【Abstract】 Objective To analyze the complications resulting from central vein catheterization and their treatment in hemodialysis patients. Methods A retrospective study was performed on 1269 cases treated with hemodialysis using central venous catheters during January, 2005 to September, 2007. Of them, 409 had catheterizations through femoral vein, 544 through external jugular vein, 285 through internal jugular vein, and 31 had permanent catheterizations. Result The average indwelling time of the catheters was 3 weeks for catheterizations through femoral vein, 4 months for those through internal or external jugular vein, and 11 months for permanent catheterizations. The acute complications of the catheterizations included inadvertent puncture to arteries (2.36%), hematoma (2.13%) and local blood infiltration (1.26%). The complications of long-term indwelling catheterizations were infection (6.38%) and insufficient blood flow through catheter (5.04%). Infections included local infection (6.38%) and catheter infection (2.83%). The local infection rate and catheter infection rate were highest (10.27% and 3.67%, respectively) in patients with catheterization through femoral vein, resulting in shorter indwelling duration in these patients. The infection rate had no difference between patients through internal and external jugular vein catheterizations. We changed dressing everyday for local infection, and sealed the catheter with gentamicine 80,000 units and urokinas 10,000 units for catheter infection. If the catheter infection improved after this sealing method for 2-3 times, we continued to use this method for 2 weeks. If this sealing method was no useful, we removed the catheter. The causes of insufficient blood flow through catheter included the catheters adhered to vessel wall, angled and blocked by thrombosis in it, which were usually seen in patients using cuffed catheter. Change of catheter position was usually found in catheterization through external jugular vein (2.57%), probably due to the local anatomical features. Conclusion Central venous catheterization is an ideal vascular access for hemodialysis. However, careful must be paid to the appropriate indications, skilled operation technique, and prevention and treatment of its complications.

Key words: Vascular access, Central vein catheterization, Complication

中图分类号: