【摘要】 目的 探讨血液透析用中心静脉置管术安全有效的操作方法及减少近期并发症的措施。方法 回顾性分析成都军区总医院肾内科近9年的中心静脉置管术，统计使用盲穿、B超定位、B超引导三种方法穿刺颈内静脉、股静脉和颈外静脉的例数、一次成功率和发生并发症的种类及例数。结果 866例中颈内静脉置管术617例，股静脉置管术245例，颈外静脉置管术4例；常规盲穿512例，其中一次成功421例(82.2%)，发生局部血肿10例(1.9%)，误穿动脉33例(6.4%)，伤及神经4例(0.8%)，皮下气肿 1例(0.2%)；B超定位257例，其中一次成功238例(92.6%)，发生血肿1例(0.4%)，误穿动脉2例(0.8%)，未发生其他并发症；B超引导97例，一次成功92例(94.8%)，未发生并发症；与常规盲穿比较，超声定位和引导穿刺的一次成功率明显提高(P＜0.001,P=0.002)，近期并发症的发生率明显降低。结论 血液透析用中心静脉置管术是一种风险较大的有创性操作，掌握正确的操作方法和采用超声辅助穿刺能有效降低风险，减少并发症，提高成功率。

【Abstract】Objective To explore the safe method of central vein catheterization for hemodialysis and the measures to reduce the early complications. Methods We retrospectively analyzed 866 cases using central vein catheterization for hemodialysis. Different catheterization methods were adopted, including blind catheterization, and internal jugular vein, femoral vein and external jugular vein catheterization by ultrasound localization or ultrasound guidance. Complications and the rate of successful catheterization were also evaluated. Results Central vein catheterization was performed for a total of 866 cases, including 617 cases of internal jugular vein catheterization, 245 cases of femoral vein catheterization, and 4 cases of external jugular vein catheterization. Of the 512 cases using blind catheterization, successful catheterization was found in 421 (82.2%) cases, local hematoma in 10 (1.9%) cases, misplacement into arteries in 33 (6.4%) cases, nerve injury in 4 (0.8%) cases, and subcutaneous emphysema in 1 (0.2%) case. Of the 257 cases using ultrasound localization for catheterization, successful catheterization was found in 238 (92.6%) cases, hematoma in 1 (0.4%) case, and misplacement into arteries in 2 (0.8%) cases. Of the 97 cases using ultrasound guidance for catheterization, successful catheterization was found in 92 (94.8%) cases, and no complications occurred. Central vein catheterization by ultrasound localization or by ultrasound guidance was associated with a higher successful rate (P＜0.001 and P＜0.002, respectively, as compared with that of blind catheterization) and a lower complication rate. Conclusion Central vein catheterization for hemodialysis is a traumatic operation with risks. Corrected manipulation and vein puncture guided by ultrasound are helpful for successful catheterization and avoidance of risks and complications.