血液透析患者临时中心静脉插管导致的相关并发症分析

Analysis on catheter-related complications caused by temporary central venous catheterization in hemodialysis patients

目的探讨临时中心静脉插管的血液透析患者发生的导管相关并发症及其与插管时间、部位的关系。方法选取我科135例患者计164例次采用临时中心静脉插管的血液透析患者为研究对象,分析不同插管部位、置管时间等因素对导管相关感染、导管功能不全、上腔静脉阻塞综合征等并发症的影响。结果①共27例患者出现导管相关感染,发生率为16.5%。不同置管部位感染发生率不同(P<0.05),股静脉发生率较高(33.3%)。不同置管时间也会影响感染发生率(P<0.05),置管时间超过两周的患者感染率(29.6%)显著高于置管低于2周患者(10.9%)。②共19例患者出现导管功能不全,发生率为11.6%。不同置管部位导管功能不全的发生率不同(P<0.05),颈内静脉较低(5.9%);置管时间也对导管功能不全的发生率具有明显影响(P<0.05),超过2周的患者导管功能不全发生率(29.6%)显著高于置管时间低于2周的患者(2.7%),无一例患者发生上腔静脉阻塞综合征。结论血液透析临时导管引起的并发症应引起临床医生的关注,而留置部位和时间是影响并发症的重要因素。为了有效预防并发症,应保持透析室的环境,严格进行无菌操作,尽量缩短置管时间,选取合适的部位置管,将降低并发症的发生率。

Objective To explore the relationship of catheter-related complications caused by temporary central venous catheterization with the catheter site and the indwelling time in hemodialysis patients. Methods One hundred and thirty-five hemodialysis patients in our department （undergoing 164 cases of temporary central venous catheterization） were selected as the research objects. Effect of different catheter sites, indwelling time of catheter on atheter-related infection, catheter dysfunction, superior vena cava obstruction syndrome and other complications were analyzed. Results ① A total of 27 cases of catheter-related infection occurred. with the incidence of 16.4%. The incidence of infection differed significantly at different catheter sites （P〈0.05）, with a high incidence in femoral vein （22.1%）. The indwelling time also significantly influenced the incidence of infection （P〈0.05）, which is significantly higher in patients with indwelling time longer than 2 weeks （20.8%） than those with indwelling time less than 2 weeks （9.5%）. ② A total of 19 patients were found with catheter dysfunction, with the incidence of 11.6%. The incidence of catheter dysfunction differed significantly at different catheter sites （P〈0.05）, which is relatively low in internal jugular vein （2.3%）. The indwelling time also had significant influence on the incidence of catheter dysfunction （P〈0.05）. The incidence was significantly higher in patients with indwelling time more than 2 weeks （29.6%） than those with indwelling time less than 2 week （2.7%）. No patients occurred superior vena cava obstruction syndrome. Conclusion The catheter-related complications caused by temporary central venous catheterization in hemodialysis patients should be paid attention to by clinicians. The catheter site and indwelling time are the important factors that influence of the incidence of complications. In order to effectively prevent complications, we should maintain the environment of dialysis room, strictly carry out aseptic operation, shorten the time of tube placement, and select the appropriate position of pipe.