单针双腔股静脉临时导管反接在血液透析中的临床应用

Clinical Application of Inverse Connection of Single-needle Double-lumen Temporary Catheters in Femoral Vein in Hemodialysis

【目的】探讨单针双腔股静脉临时导管反接在血液透析中的临床应用价值。【方法】选择37例初始血液透析病人，合并活动性出血或高危出血倾向，或处于围手术期，予单针双腔临时股静脉导管置管和无肝素透析，随机分为反接透析组（17例）和正接透析组（20例）。比较透析失衡综合征发生率、管路和透析器凝血情况、血浆渗透压改变以及尿素清除指数（KT／V）。【结果】比较两组透析失衡综合征发生率、血浆渗透压改变、KT／V值无统计学差异（P〉0．05），反接组严重凝血（Ⅱ级和Ⅲ级）发生率低（P〈0．05）。【结论】单针双腔股静脉临时导管反接用于初始血液透析合并活动性出血或高危出血倾向，或处于围手术期病人，较正接方式疗效相当，安全性更好。

[Objective]To investigate the clinical value of inverse connection of single-needle double-lumen temporary catheters in femoral vein in hemodialysis. [Methods]Thirty seven initial hemodialysis patients complicated with active bleeding, high-risk hemorrhagic tendency or in the perioperative period were selected and randomly divided into inverse connection hemodialysis group（ n = 17） and normal connection hemodialysis group（ n = 20）. All patients were treated with femoral vein catheterization with single-needle double-lumen temporary catheters and heparin-free hemodialysis. The incidence of dialysis disequilibrium syndrome（DDS）, the blood coagulation in tubes and dialyzers, the change of plasma osmotic pressure and urea clearance index （KT/V） were compared between two groups. [Results] There was no statistical difference in the incidence of DDS, the change of plasma osmotic pressure and KT/V between two groups（ P 〉 0.05）. The incidence of severe coagulation was lower in the inverse connection group（ P 〈0.05）. [Conclusion]Compared with normal connection of single-needle double-lumen temporary catheters in femoral vein, the inverse connection of cathe ter has the same effect, but is safer for initial hemodialysis patients complicated with active bleeding, high risk hemorrhage tendency or in the perioperative period.