246例次深静脉置管急诊血液透析治疗的安全性分析

The safety analysis of 246 cases emergent hemodialysis with profound venous catheters

目的 深静脉置管急诊血液透析是肾脏替代治疗的一种有效手段。本文通过对不同深静脉置管部位出现的并发症进行分析,以寻找最佳的深静脉置管急诊血液透析的方式。方法 本文分析了1993年1月至2000年6月期间,因急慢性肾功能衰竭行深静脉置管急诊血液透析治疗的住院患者。置管部位为股静脉、锁骨下静脉和颈内静脉。肝素封管方法为大剂量常规肝素一次性封管和小剂量肝素多次封管两种。结果 219例患者接受了246例次深静脉置管急诊血液透析治疗,平均置管保留时间为19.6天,合并症发生率为28.0％。股静脉置管平均保留时间为(16.89±8.11)天,合并症发生率为30.4％;锁骨下静脉置管平均保留时间为(19.85±12.10)天,合并症的发生率为38.9％;颈内静脉置管平均保留时间为(25.21±10.95)天,合并症的发生率为10.2％,与股静脉或锁骨下静脉置管相比有显著性差异(P<0.05)。结论 颈内静脉置管行急诊血液透析置管保留时间最长,合并症发生率最低,最为安全可靠,应为急诊血液透析治疗首选的临时血普通路。股静脉置管方法操作方便,相对安全,但影响患者活动。锁骨下静脉置管可出现较为严重的并发症,危险性较大,不建议作为急诊血液透析治疗时的临时血管通路。

Objective To analysis the vascular catheter - related complications in retrospective way and to find the best way of deep venous catheterization for emergent hemodialysis( HD).Methods The in - hospital patients received deep venous catheterization for emergent HD because of acute or chronic renal failure from Jan 1993 to Jun 2000.Catheter locations were femoral,subclavian and internal jugular vein.Heparin was used for sealing catheters,with only once during inter - dialysis session or twice every day.Results There were 219 patients received 246 treatments with deep vein catheterization for the purpose of emergent HD.The average period of maintaining catheters was 19.6 days.The total incidence of complications was 28.0%.The average period of catheters maintaining for internal jugular vein was longer than that of femoral and subclavian vein (25.21 +10.95) days,(16.89+8.11) days,P<0.057(25.21 + 10.95) days,(19.85+ 12.10) days,P< 0.05,respectively.The incidence of catheter - related complications of internal jugular vein (10.2%) was lower than that of femoral (30.4%,P < 0.05) and subclavian vein (38.9% ,P < 0.05).Conclusion Internal jugular vein catheterization is the first choice of temporary access for emergent HD.