中国血液净化

中国血液净化 ›› 2017, Vol. 16 ›› Issue (03): 204-207.doi: 10.3969/j.issn.1671-4091.2017.03.016

• 血管通路 • 上一篇    下一篇

经皮无名静脉穿刺技术建立长期血液透析通路的临床研究

周芹1,焦河2,刘春乘3,于洋1,崔天蕾1   

  1. 四川大学华西医院1肾脏内科，2介入科， 3超声科
  • 收稿日期:2016-10-17 修回日期:2017-02-03 出版日期:2017-03-12 发布日期:2017-03-12
  • 通讯作者: 崔天蕾 tianleicui@163.com E-mail:tianleicui@163.com

A clinical study of percutaneous innominate vein catheterization for long-term hemodialysis vascular access

  • Received:2016-10-17 Revised:2017-02-03 Online:2017-03-12 Published:2017-03-12

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摘要： 目的评估经皮无名静脉穿刺技术建立长期血液透析通路的安全性和有效性。方法选取2014 年1 月～2016 年1 月四川大学华西医院符合无名静脉穿刺建立长期血液透析通路条件的终末期肾脏病患者，收集患者既往病史，完善术前检查，在X 线引导下行无名静脉穿刺并置入隧道式透析导管。记录手术并发症情况及随访评估血管通路效果。结果共纳入19 例患者(男性4 例，21.1%)，平均年龄63.6±8.4 岁，中位透析龄30[10,84]月。所有患者均穿刺顺利并成功置入透析导管。术后所有患者导管功能良好。出院后患者中位随访时间12[6,20]月，1 例患者因上消化道出血死亡，未发生置管相关的死亡或其他严重并发症，全因死亡率5.2%。1 例患者发生导管相关感染，3 例患者因导管功能障碍入院，治疗后导管均可继续使用，余患者通路功能正常；通路1 年原发通畅率84.2%，继发通畅率100%。结论X 线引导下，经皮无名静脉穿刺技术建立长期血液透析通具有较高的安全性和有效性。

关键词: 血液透析通路, 中心静脉置管, 无名静脉, 终末期肾脏病

Abstract: Objective This study aims to evaluate the safety and efficacy of percutaneous innominate vein catheterization for long-term hemodialysis vascular access. Method End-stage renal disease patients requiring long-term central venous access, suitable for innominate vein catheterization and treated in our hospital from Jan. 2014 to Jan. 2016 were enrolled in this study. Clinical history and preoperative examinations were carefully evaluated. Innominate vein catheterization was performed under X-ray fluoroscopy. Procedurerelated complications were recorded, and the patency of hemodialysis access was followed up. Results A total of 19 patients (4 male, 21.1%) were included in this study, with an average age of 63.6±8.4 yr and a median dialysis time of 30 (10, 84) months. All patients were successfully operated, and the catheters functioned well immediately after catheterization. After discharge, the patients were followed up for a median of 12 (6,20) months. All patients survived except one patient who died of upper gastrointestinal bleeding. No procedure- related major complication occurred. Three patients (15.8%) were hospitalized for access dysfunction, and the catheter function recovered after proper manipulation. The 12-month primary patency of accesses was 84.2%, and the secondary patency reached 100%. Conclusion Percutaneous innominate vein catheterization established under fluoroscopy guidance is safe and efficient for long-term hemodialysis access

Key words: hemodialysis vascular access, central venous catheterization, innominate vein, end-stage renal disease