不同置管途径对血液透析长期留置导管并发症的影响

Comparison of complications by different sites of catheterization for long-term hemodialysis

目的:探讨建立血液透析长期留置导管的最佳置管途径。方法:将185例血液透析患者分3组,分别采用颈内静脉(95例)、颈外静脉(65例)、股静脉(25例)途径建立长期导管,比较不同置管途径的穿刺成功率、穿刺过程并发症及置管期间并发症发生情况。结果:颈内静脉、颈外静脉、股静脉置管穿刺成功率分别为94.74%、93.84%、92.00%,差异无统计学意义(P>0.05);穿刺过程并发症比较,其中误入动脉差异有统计学意义(P<0.01),其余并发症差异不大;置管期间并发症颈内静脉组与颈外静脉组无明显不同(P>0.05),股静脉组与其他两组比较差异均有统计学意义(P<0.01)。结论:颈内静脉是血液透析长期置管的首选途径;颈外静脉可作为置管的第二级血管;尽可能不选择股静脉途径置管。

Objective：To find a best site to catheterize for long-term hemodialysis.Methods：One hundred and eighty-five cases of hemodialysis were divided,according to the catheterization sites,into internal jugular vein group（95 cases）,external jugular vein group（65 case）and femoral vein group（25 cases）.The success rate of puncture,the incidence of complications during the puncture procedure and the catheterization were compared.Results：The success rates of puncture were 94.74%,93.84% and 92.00% in the internal jugular vein group,external jugular vein group and femoral vein group,respectively.The difference was not significant（P0.05）.The incidence of straying into the artery was significant higher in the femoral vein group than that in the other two groups（P0.01）,and the incidence of other complications had no significant difference among the three groups（P0.05）.The incidence of complication during catheterization had no significant difference between the internal jugular vein group and the external jugular vein group,while the femoral vein group presented a higher incidence of complication（P0.01）.Conclusions：The internal jugular vein puncture is a preferred means of catheterization for long-term hemodialysis,and the external jugular vein can be used as a second-class vessel for catheterization.The femoral vein can only be considered when the above veins are not accessible.