血透患者永久性中心静脉置管相关并发症的临床分析

Application of Permanent Venous Catheterization in Hemodialysis

目的:分析维持性血液透析患者永久性中心静脉置管的并发症及处理,探讨预防措施。方法:回顾性分析我院2003年1月～2009年12月维持性血液透析患者168例,留置永久性中心静脉导管置管82例次,其中有11例患者重复置管(2～3)次。右颈内静脉置管134例,左颈内静脉置管4例,锁骨下静脉置管13例,股静脉置管31例。结果:导管留置时间:平均留置时间(14士12)月,其中颈内静脉(4～36)月,平均16月;锁骨下静脉(3～25)月,平均11月;股静脉(2～7)月,平均4月。导管置管时相关的并发症主要为:局部血肿17例(9.0%)、渗血21例(12%)和导管功能障碍3例(1.6%)。导管留置过程中的主要并发症为导管通路功能障碍和感染,本组导管通路功能障碍13例(7.0%),其中血栓形成8例、隧道段打折2例,导管外鞘形成1例,血管狭窄1例。10例导管通路功能障碍经调整导管、尿激酶溶栓或手术修复,得到纠正,余3例拔管后重新进行穿刺置管。本组有15例患者发生局部感染(8.0%),给予消毒换药,管周皮肤涂察百多帮软膏后好转。结论:永久性中心静脉留置导管可作为血液透析患者较为理想的血管通路,但仍应熟练掌握操作技术,重点防治置管期间局部巨大血肿和渗血以及导管留置期间血栓形成和局部感染。

Objective：To analyze the complications resulting from Permanent central vein catheterization and their treatment in hemodialysis patients.Methods：A retrospective study was performed on 168 cases treated with hemodialysis using permanent central venous catheters during January, 2003 to December, 2009. 138 had catheterizations through internal jugular vein, 31 had catheterizations through femoral vein, 13 through Subclavian vein.Results：The average indwelling time of the catheters was （14_-I= 12） months, of them, 4-36 months for catheterizations through intemal jugular vein,3-25 months through Subclavian vein,2-7 months through femoral vein. The acute complications of the catheterizations included hematoma （9.0%） and local blood infiltration （12%）. The complications of long-term indwelling catheterizations were dysfunction of catheter （7.0%） and infection （9.0%）.Infection included local infection （6.9%） and catheter infection （2.1%）. The causes of dysfunction of catheter included the catheters adhered to vessel wall, angled and blocked by thrombosis in it, which were usually seen in patients using cuffed catheter.Conclusion：Permanent central venous catheterization is an ideal vascular access for hemodialysis. However, skilled operation technique and prevention and treatment of its complications are valuable.