血液透析中心静脉置管出血性并发症的分析

The analysis of the hemorrhage complications of temporary central venous catheter in hemodialysis patients

目的回顾性分析血液透析患者临时中心静脉置管出血并发症发生的原因。方法回顾性分析471例接受临时中心静脉置管的血液透析患者资料，分析置管位置（颈内、锁骨下、股静脉）、置管后透析时机（即刻或隔日）、透析中抗凝方式（普通肝素、低分子量肝素和无肝素）与出血并发症的关系。结果①置管后即刻透析患者发生出血并发症的风险较隔日透析高（16．4％ vs 4．2％，P〈0．01）；②低分子量肝素抗凝较普通肝素抗凝出血少（5．2％ vs 13．8％，P〈0．01）。结论恰当的安排透析时机、选用合适的抗凝技术以可有效减少中心静脉置管患者出血并发症的发生。

Objective To analyse retrospectly the causes of the hemorrhage complications of temporary central venous catheter in hemodialysis patients. Methods The clinical date of 471 hemodialysis patients who accecpted temporary central venous catheter were collected. Various cathetering locations include jugular vein, infraclavicular vein and femoral vein were compared, while various hemodialysis time and anticoagulation agents were also studied. Results 1.The hemorrhage accidents was more frequency in the patients who accecpted hemodialysis just after placing catheter than those who accecpted hemodailysis in the second day（16. 4% vs. 4. 2 %, P〈0. 01 ） ;2. Low molecular weight heparin decreased the hemorrhage accidents compared with the common heparin （5. 2% vs. 13. 8%, P〈0. 01）. Conclusions Proper dialysis time and suitable anticoagulation agents may decrease the incidence of hemorrage complications of temporary central venous catheter in hemodialysis patients.