中国血液净化

中国血液净化 ›› 2019, Vol. 18 ›› Issue (11): 776-779.doi: 10.3969/j.issn.1671-4091.2019.11.012

• 血管通路 • 上一篇    下一篇

股静脉留置带隧道带涤纶套导管在血液透析中的应用体会

沈杰1,2,周蓉2,陈希2,王雅楠2,徐雅虹2,戴兵1   

  1. 1第二军医大学附属长征医院肾内科
    2同济大学附属杨浦医院肾内科

  • 收稿日期:2019-03-29 修回日期:2019-09-11 出版日期:2019-11-12 发布日期:2019-10-28
  • 通讯作者: 戴兵 czdaibing@smmu.edu.cn E-mail:czdaibing@smmu.edu.cn

The application of indwelling tunneled cuffed catheter in femoral vein for hemodialysis

  1. 1Department of Nephrology, Changzheng Hospital, the Second Military Medical University, Shanghai 200003, China;  2Department of Nephrology, Yangpu Hospital, Tongji University, Shanghai 200090, China
  • Received:2019-03-29 Revised:2019-09-11 Online:2019-11-12 Published:2019-10-28

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摘要： 【摘要】目的探讨股静脉留置带隧道带涤纶套导管(tunneled cuffed catheter，TCC)在血液透析中的应用。方法选取2016 年1 月～2017 年12 月同济大学附属杨浦医院肾内科42 例使用TCC 及32 例颈内静脉留置TCC 行血液透析的尿毒症患者，观察2 组导管的使用情况。结果4 周和24 周时2 组患者的尿素清除指数无统计学差异(t 值分别为0.429,1.231；P 值分别为0.670,0.225)；4 周、12 周、24 周和36周时股静脉组导管功能不良发生率明显升高(χ2 值分别为5.891，51.080，20.857，24.000；P 值分别为0.017，＜0.001，＜0.001，＜0.001)，使用小剂量尿激酶(5000IU/ml)封管后2 组的血流量均能满足透析需求；股静脉组有3 例发生导管相关性感染，颈内静脉组无；2 组均无深静脉血栓发生。6 个月后，股静脉组需要的尿激酶剂量明显升高；尿素清除指数较前明显下降(t=3.351，P =0.002)，与颈内静脉组相比明显下降(t=3.810，P=0.001)；感染及静脉血栓发生率升高。结论对需中心静脉导管过渡的患者，短期(＜24 周)透析使用股静脉TCC 能达到良好的透析效果，可避免中心静脉狭窄，不影响患者建立自体动静脉瘘或人工血管动静脉瘘。

关键词: 带隧道带涤纶套导管, 股静脉, 颈内静脉, 血液透析, 血管通路

Abstract: 【Abstract】Objective To investigate the application of indwelling tunneled cuffed catheter (TCC) in femoral vein for hemodialysis. Method Forty-two patients with TCC indwelling in femoral vein and 32 patients with TCC indwelling in internal jugular vein for maintenance hemodialysis during January 2016 to December 2017 were enrolled in this study. The applications of these catheters were analyzed. Results There was no significant difference in urea clearance index between the two groups using the catheters for 4 and 24 weeks (t=0.429, P=0.670 for 4 weeks; t=1.231, P=0.225 for 24 weeks). The incidence of catheter dysfunction was obviously higher in femoral vein group than in internal jugular vein group (χ2=5.891, P=0.017 for 4
weeks; χ2=51.080, P=0.000 for 12 weeks; χ2=20.857, P=0.000 for 24 weeks; χ2=24.000, P=0.000 for 36 weeks); but the blood flow of the two groups still met with the dialysis requirement after sealing the catheters with a low dose of urokinase (5000 IU/ml). Catheter- related infection developed in 3 cases in femoral vein group, but not found in internal jugular vein group. No deep vein thrombosis occurred in both groups. After 6 months in femoral vein group, the dose of urokinase increased obviously, urea clearance index decreased significantly (t=3.810, P=0.001) lower than that in internal jugular vein group (t= 3.810, P=0.001), and the rate of infection and venous thrombosis increased. Conclusion TCC indwelling in femoral vein for a short period of time (<24 weeks) can be used in patients requiring a transitional blood access for hemodialysis. This method
avoids central venous stenosis and does not interfere with the establishment of autologous arteriovenous fistula or arteriovenous fistula graft.

Key words: Tunneled cuffed catheter, Femoral vein, Internal jugular vein, Hemodialysis, Vascular access

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