带袖套的中心静脉留置导管(TCC)的临床相关研究

A clinical study relating to the use of tunneled cuffed venous catheter for central venous indwelling catheterization

目的近年在我国带袖套的中心静脉留置导管(tunneled cuffed catheter,TCC)广泛应用于血液透析,本文对其应用于慢性血液透析的实用价值、具体操作方法、规范化管理、并发症及其预防治疗进行了探讨和分析。方法选择慢性血液透析患者61例,进行TCC插管72例次,其中男性21例、女性40例,年龄22～82岁,糖尿病肾病30例,慢性肾小球肾炎23例,梗阻性肾病2例,马兜铃酸肾病3例,狼疮性肾炎1例,高血压肾病2例。结果现阶段应用TCC作为维持性血液通路27例,占透析中心同期透析患者的23%。最长使用时间36个月,平均时间(12.0±1.1)个月。血液流量200～300ml/min。并发症情况:①感染:其中出口感染3例;导管相关菌血症3例。②导管功能不良:导管扭曲、位置不适当7例;血栓性并发症19例;导管完全脱出3例,部分脱出2例。均进行相应处理。结论通过6年的临床实践,我们认为TCC有很重要实用价值:可以作为长期血管通路使用;作为等待动静脉内瘘成熟期间非常理想的过渡通路;较人造血管内瘘具有操作简单、价格便宜、可以急诊使用等优点。预防和治疗并发症是TCC管理的重点,重在规范化管理,对于并发症及时进行处理。

Objective Tunneled cuffed catheter （TCC） has been widely used for hemodialysis for many years in China. Here we summarize and analyze its practical value,operation method,standardized management,and the prevention and treatment of its complications. Methods We collected 61 maintenance hemodialysis dialysis patients （male 21,female 40）,including diabetic nephropathy 30 cases,chronic nephritis 23 cases,obstructive nephropathy 2 cases,aristolochic acid nephropathy 3 cases,lupus nephritis one case,and hypertension nephropathy 2 cases for this study. Results TCC for hemodialysis was used in 27 patients,accounting for 23% of total patients in the dialysis center in the study period. The longest duration using TCC lasted for 36 months,with the average of 12.0 ± 1.1 months. Blood flow rate in the catheter ranged 200-300ml/min. Complications consisted of （a） exit site infection in 3 cases,and catheter related bacteremia in 3 cases,and （b） TCC dysfunction including twist or cacothesis of TCC in 7 cases,thrombosis in 19 cases,partially coming off of TCC in 2 cases,and coming away of TCC in 3 cases. All complications could be treated properly. Conclusion TCC possesses important and practical values for maintenance hemodialysis. It can be used as a long-term vascular access,or as a provisional measure before the maturation of A-V fistula. Compared with graft fistula,TCC has the advantages of easy manipulation and lower cost,and is also suitable for emergency patients. Care must be paid to the prevention and treatment of its complications,and the appropriate management of TCC.