肝衰竭患者深静脉置管的选择

Choice for deep venous catheterization in patients with liver failure

目的:探讨肝衰竭患者理想的深静脉置管方式。方法:肝衰竭患者根据病情选择不同深静脉置管方式,观察患者发生血肿、穿刺点渗血、瘀斑、导管感染等并发症发生率。结果:股静脉穿刺瘀斑发生率明显高于颈内静脉(P<0.01);颈内静脉穿刺点渗血明显高于股静脉(P<0.01);动脉损伤发生率股静脉穿刺高于颈内静脉(P<0.05)。同一患者颈内静脉穿刺点发生渗血高于股静脉(P<0.05),股静脉的瘀斑发生率高于颈内静脉(P<0.001)。结论:颈内静脉是肝衰竭患者最安全、最常用的深静脉置管位置,当进行血液净化、血浆置换等治疗时,股静脉可以作为置管首选方式。

Objective：To investigate the optimal catheterization access in patients with liver failure. Methods： Different ways of deep venous catheterization were done based on clinical needs in patients with liver failure, incidence of complications such as hematoma, bleeding at the puncture point, ecchymosis, catheter-related infections were observed. Results： Incidence of femoral vein puncture related ecchymosis was significantly higher than that of internal jugular vein （P〈0. 01）. Bleeding from internal jugular vein puncture point was obviously higher than that from femoral vein （P 〈0. 01） and artery injuries in femoral vein group was higher than that in internal jugular vein （P〈0. 05）. The incidence of bleeding at puncture point for internal jugular vein catheterization was higher than that for femoral vein in the same patients （P〈0. 05）, ecchymosis in femoral vein puncture was higher than that in internal jugular vein （P〈 0. 001）. Conclusions： Internal jugular vein is the safest and the most extensively used deep venous catheterization way in patients with liver failure. Femoral vein is the preferred way when blood purification, and plasma exchange are needed.