半永久性中心静脉留置导管在血液透析中的临床应用

Clinical Application of Semi-permanent Central Venous Catheters in Hemodialysis

目的探讨半永久性中心静脉留置导管在血液透析中的临床应用。方法对解放军第309医院旃坛寺门诊部血液净化中心在2007年1月至2012年1月行间心中心静脉留置导管的753例患者的临床资料进行回顾性分析,其中368例半永久性颈内静脉双腔留置导管治疗,385例临时性颈内静脉双腔留置导管治疗,半永久性颈内静脉留置导管采用美国Permcatch带涤纶套双腔导管,临时性双腔导管留置应用Seldinger技术,分析半永久性中心静脉留置导管在血液透析中的安全性和疗效。结果半永久性颈内静脉双腔导管留置时间长,导管功能不良占10.10%,感染占6.56%,临时性颈内静脉双腔导管留置时间短,导管功能不良占27.6%,感染占27.38%,差异有统计学意义(P<0.05)。结论半永久性中心静脉留置导管操作简单、安全、方便、并发症低,解决了由于患者自身血管条件而不能做内瘘或人造血管的血液透析,为临床需要透析的患者提供宝贵意见,值得临床推广。

Objective To investigate the clinical application of semi-permanent central venous catheter in hemodialysis. Methods The clinical data of a total of 753 cases treated with central venous catheter （CVT） in Blood Purification Genter of Zhantansi Out-patient Department of PLA NO. 309 Hospital from January 2007 to January 2012 were retrospectively analyzed,including 368 cases of semi-permanent dual lumen indwelling catheter treatment via internal jugular vein and 385 cases of temporary dual lumen indwelling catheter treatment via internal jugular vein. The semi-permanent dual lumen indwelling catheter treatment were performed with double-lumen catheter from U. S. Permcatch with polyester sets while Seldinger technique was applied in temporary dual lumen indwelling catheter treatment, and then the safety and efficacy of semi-permanent dual lumen indwelling catheter treatment via internal jugular vein in hemodialysis were analyzed. Results Comparing two types of CVT treatment,the semi-permanent dual lumen catheter was indwelled for longer time, catheter dysfunction accounted for 10. 10% and infection for 6.56%, while temporary dual lumen catheter was indwetled for shorter time, catheter dysfunction accounted for 27.6% and infection for 27.38% ,and the differences were statistically significant （ P 〈 O. 05 ）. Conclusion The semi-permanent dual lumen indwelling catheter treatment via internal jugular vein is simple, safe and convenient with low complication, solving the disable utilization of fistula or artificial blood vessels in hemodialysis because of the patient＇s own vascular conditions,which is worthy of clinical promotion.