中国血液净化

中国血液净化 ›› 2026, Vol. 25 ›› Issue (01): 64-67.doi: 10.3969/j.issn.1671-4091.2026.01.015

• 血管通路 • 上一篇    下一篇

坐位颈内静脉置管术在急性左心力衰竭患者血液透析中的应用：一项回顾性队列研究

王海欣    付永胜   

  1. 010031 呼和浩特，1内蒙古医科大学附属医院肾内科
  • 收稿日期:2025-06-05 修回日期:2025-10-15 出版日期:2026-01-12 发布日期:2025-12-31
  • 通讯作者: 付永胜 E-mail:superkakaxi1991@foxmail.com

Application of internal jugular vein catheterization at sitting position in hemodialysis with acute left heart failure: a retrospective cohort study

WANG Hai-xin, FU Yong-sheng   

  1. Department of Nephrology, the Affiliated Hospital of Inner Mongolia Medical University, Hohhot 010031, China
  • Received:2025-06-05 Revised:2025-10-15 Online:2026-01-12 Published:2025-12-31
  • Contact: 010031 呼和浩特，1内蒙古医科大学附属医院肾内科 E-mail:superkakaxi1991@foxmail.com

摘要： 目的  系统评估坐位颈内静脉置管术(sitting position internal jugular vein catheterization，SP-IJVC)在急性左心力衰竭(acute left heart failure ,ALHF)患者中的安全性及有效性，并与传统股静脉置管(femoral vein catheterization,FVC)对比。 方法  回顾性纳入2020年1月—2024年5月内蒙古医科大学附属医院收治的ALHF患者，分为SP-IJVC组与FVC组。主要结局包括操作成功率及并发症发生率，次要结局为导管通畅时间及血栓发生率。 结果  共纳入37例患者，其中SP-IJVC组17例、FVC组20例。SP-IJVC组操作成功率100%，并发症率11.8%(2/17)，低于FVC组的25.0%(5/20)(χ2=4.682，P=0.032)。SP-IJVC组导管平均通畅时间为(16.2±3.5)d，长于FVC组的(10.8±2.1)d(t=5.573，P＜0.001)；SP-IJVC组血栓发生率为5.9%(1/17)，低于FVC组的22.1%(4/18)(χ2=4.021，    P=0.045)。SP-IJVC亚组分析显示：超声引导组(n=12)并发症率为8.3%(1/12)，盲穿组(n=5)为20.0% (1/5)，2组间比较差异无统计学意义(χ2=0.578，P=0.447)；后入路法(n=11)操作时间为(8.5±2.1)min，短于前入路法(n=6)的(11.2±3.4)min(t=2.531，P=0.021)。 结论  SP-IJVC为无法平卧的ALHF患者提供安全、有效的血管通路选择，其导管功能及安全性优于FVC，推荐作为此类患者的首选术式。

关键词: 颈内静脉置管, 急性左心力衰竭, 血液透析

Abstract: Objective To systematically evaluate the safety and effectiveness of sitting position internal jugular vein catheterization (SP-IJVC) in patients with acute left heart failure (ALHF) and to compare SP-IJVC with traditional femoral vein catheterization (FVC).  Methods The patients with ALHF admitted to the Affiliated Hospital of Inner Mongolia Medical University from January 2020 to May 2024 were retrospectively divided into SP-IJVC group (n=17) and FVC group (n=20). The main outcome includes success rate of operation and incidence of complications, and the secondary outcome included patency period of the catheters and incidence of thrombosis. Python 3.8 was used for statistical analysis. Independent sample t-test was used for comparison of numerical data between groups, and Fisher's exact test or chi-square test was used for comparison of counting data between groups.  Results  A total of 37 patients were included in this study. In SP-IJVC group, the operation success rate was 100%, and the complication rate was 11.8% (2/17), lower than the rate of 25.0% (5/20) in FVC group (χ²=4.682, P=0.032); the average catheter patency period was 16.2±3.5 days, longer than the period of 10.8±2.1 days in FVC group (t=5.573, P＜0.001); the thrombosis rate was 5.9% (1/17), lower than the rate of 22.1% (4/18) in FVC group (χ²=4.021, P=0.045). Subgroup analysis of SP-IJVC group showed that the complication rate was 8.3% (1/12) in ultrasound-guided subgroup (n=12) and was 20.0% (1/5) in blind puncture subgroup (n=5), without statistically significant difference between the two groups (χ²=0.578, P=0.447); the operation time  was 8.5±2.1 minutes for posterior approach (n=11), shorter than the time of 11.2±3.4 minutes for anterior approach (n=6) (t=2.531, P=0.021).  Conclusion  SP-IJVC provides a safe and effective vascular access option for patients with ALHF who can't lie flat, and the catheter function and safety are superior to FVC method. We recommend SP-IJVC as the first choice for these ALHF patients.

Key words: nternal jugular vein catheterization, Acute left heart failure, Hemodialysis

中图分类号: