经皮下隧道双腔带Cuff导管在血液透析中的应用分析

Clinical analysis of tunneled cuffed dual-lumen catheter in hemodialysis

目的寻求延长双腔带Cuff中心静脉留置导管使用时间和减少并发症发生的方法。方法回顾性分析30例经右颈内静脉留置双腔带Cuff中心静脉留置导管的病人的临床资料，分析其术后并发症发生情况、血液透析时血流量、感染、血栓形成、中心静脉狭窄的发生情况。结果带cuff的中心静脉留置导管术后并发症以隧道出血多见，经过压迫均愈合良好；有11例患者至今仍在使用，血流量在200-340ml／min，透析充分性良好；而拔除或重新置管的原因主要为感染和血栓形成，分别达40％和28％。结论双腔带cuff导管可作为一种有效的血透通路，尤其是多次建立自体动静脉内瘘失败或人造血管功能障碍等各种原因无法建立永久性血管通路时，如果通过严格的管理，其并发症的发生能进一步降低，将会有更长的使用寿命。

Objective To retrospectively analyze the complication, usage duration of tunneled cuffed dual-lumen catheter and find methods to maintain long-term catheter and reduce the complication. Methods 30 patients with chronic hemodialysis were retrospectively analyzed. Results Tunnel bleeding was the most common complication, but could be cure after compression. The blood flow reached 200-340 ml/min which could support the adequate hemodalysis. The most frequent indications for catheter removal were infections （40%） and thrombosis （28%）. Conclusion Tunneled cuffed dual-lumen catheter may be a very useful alternative permanent vascular access for hemodialysis patients when other vascular access are not available.