深静脉置管在血液透析中的临床分析

The Clinical Analysis on Application of Deep Venous Catheterization in Hemodialysis

目的探讨维持性血液透析患者深静脉置管后的并发症发生情况及治疗措施。方法 140例深静脉置管患者中,颈内静脉置管62例,股静脉置管60例,颈内静脉半永久置管18例,对其置管方法、并发症及防治措施进行回顾性分析。结果 122例临时置管(颈内静脉置管、股静脉置管)使用时间3～65 d;18例颈内静脉半永久置管使用时间为6～30个月;透析时血流量200～260 mL/min。其中1例患者发生导管相关性感染;8例患者出现穿刺部位渗血;10例患者出现血流不畅或血栓形成;2例患者发生导管脱落。结论深静脉置管是血液透析患者较理想的临时性血管通路;导管血栓形成和感染是最常见的并发症;正确的封管方法、严格的无菌操作、尿激酶溶栓和抗生素的应用能延长其使用寿命。

Objective To retrospectively analyse the complications and treatmentd of the maintenance hemodialysis patients with deep venous catheterization.Methods The tube method,complications and prevention measures140 patients with deep venous catheterization,including 62 cases of internal jugular vein catheterization,60 cases of femoral vein catheterization,18 cases of semi-permanent internal jugular vein catheterization,were analyzed retrospectively.Results Among 122 cases of temporary catheterization（jugular vein,femoral vein） with usage time of（3-65） days;18 patients with cervical vein semi-permanent catheterization with usage time of（6-30）months,blood flow（200-260） mL/min during dialysis,1 patient developed catheter-related infections;8 patients had bleeding at the puncture sites;10 patients had poor blood flow or thrombosis;2 cases catheter fell off.Conclusion Deep venous catheterization in hemodialysis patients is an ideal temporary vascular access;catheter thrombosis and infection are the most common complications;correct sealed tube method,strict aseptic operation,and the application of urokinase and antibiotics can extend its service life.