中心静脉置管在急诊血液透析治疗中的应用

Application of Central Venous Catheterization for Emergency Hemodialysis

目的总结急诊血液透析(HD)治疗患者建立临时性血管通路的经验,探讨中心静脉置管在急诊HD治疗中的应用以及中心静脉置管并发症的防治。方法回顾性分析应用临时性中心静脉置管行急诊HD治疗病例173例,其中右颈内静脉置管130例(75.2%),右锁骨下静脉置管31例(17.9%),右股静脉置管12例(6.9%),分析不同置管方法临床并发症的发生率及处理方法。结果置管术中的常见并发症有:误穿动脉13例(7.5%)、皮下血肿11例(6.3%)、穿刺部位渗血19例(11.0%);置管术常见远期并发症有:血流量不足20例(11.6%)、导管相关感染13例(7.5%)、导管栓塞9例(5.2%)、导管意外脱落8例(4.6%)。结论中心静脉置管具有方便快捷、操作技术简便、并发症少且可以预防和治疗、能提供足够血流量等优点,是建立急诊HD治疗临时性血管通路的理想方法。

Objective To investigate the clinical applications of central venous catheterizations ,and the prevention of its complications in patients who were received emergency hemodialysis （HD） therapy. Methods A retrospective study was performed in 173 cases of patients undergoing emergency HD therapy with central venous catheterizations ,which include 130（75： 2% ） cases of internal jugular venous catheterizations ,31 （ 17.9% ） cases of subclavian venous catheterizations and 12 （6.9%） cases of femoral venous catheterizations. The complications and their management were analyzed. Results The common acute complications of catheterizations included inadvertent arterial puncture （13 cases,7.5% ）,local hematoma （11 cases,6.3% ） and local bleeding （ 19 cases, 11.0% ）. The common long - term complications of catheterizations included insufficiency blood flow （20 cases, 11.6% ）, catheter-related infection （ 13 eases,7.5 % ）, catheter obstruction （ 9 cases, 5.2% ） and inadvertent withdrawal of catheter （8 case,4.6% ）. Conclusions Central venous catheterizations is convenient, simple techniques and it has a low rate of complications which can be controlled easily and safely,and it can provide sufficient blood flow,so it is a effect method to set up a temporary vascular access for emergency HD therapy.