颈内静脉半永久双腔导管在血液透析中的临床应用

Application of Jugular Vein Cuffed-Tunneled Catheters in Hemodialysis

目的探讨维持性血液透析患者颈内静脉半永久双腔导管的效果。方法对16例尿毒症患者运用Seldinger技术留置带涤纶环(Cuff)双腔导管进行维持性血液透析并观察疗效。结果所有患者导管置入后均能够正常使用,血流量均达到230～300 ml/min。Kt/V为1.44±0.15,与使用内瘘的透析患者[Kt/v=1.43±0.19(n=15)]比较差异无统计学意义;半永久双腔导管平均留置15.2个月,最长25个月,最短4个月;16例患者中,2例出现感染,经抗感染2周后治愈,感染率12.5%;4例出现血栓,经尿激酶溶栓治疗后2例治愈;血栓形成率25%,1例死于多器官功能衰竭,病死率6%。结论对于血管条件差,内瘘建立困难,需维持性血液透析的患者,应用颈内静脉半永久双腔导管进行血液透析可以达到透析充分性,是一种安全、有效的血管通路。

Objective To evaluate the application of jugular vein cuffed-tunneled catheters in hemodialysis （HD）. Methods The jugular vein cuffed-tunneled catheters were inserted in 16 patients with uremia to perform maintenance hemodialysis by using Seldinger technique, and the curative effect was estimated. Results All catheters used well and the blood flow was 230 - 300 ml/ min. The Kt/V was 1.44±0.15. There Was no observably deference as compared with A-V fistula HD patients which Kt/V was 1.43 ±0.19（n = 15）. The average survival of cuffed-tunneled catheters was 15.2 months,the longest was 25 months and the shortest was 4 months. In the 16 cases, infection occurred in 2 patients who were cured by using antibiotics 2 weeks, the proportion of infection was 12.5% ;thrombus occurred in 4 patients ,2 patients was cured by urokinase treated, the proportion of thrombus was 25% ,1 patient dead of MOF,the proportion of death was 6%. Conclusion To some HD patients whom were difficult to build the A-V fistula, the jugular vein cuffed-tunneled catheter was a safe and effective hemodialysis vascular access.