四种不同涤纶套中央静脉导管置入方法及分析

Four different the cuffed central venous catheter methods and analysis

目的 观察四种不同带涤纶套中央静脉导管置入方法并行临床分析.方法 132例患者行带涤纶套中央静脉导管置入术,分为A组（36例）经撕脱鞘置入涤纶套中心静脉导管;B组（36例）颈外静脉切开置入导管;C组（32例）通过引导钢丝并逐层扩张后直接置入导管;D组（28例）采用颈内静脉切开置入导管.结果 A、B、C、D四组透析前后肌酐、尿素氮水平变化存在统计学差异,且尿素清除指数均达标,A、B、D三组透析中血流量、回血静脉压、尿素清除指数以及导管留存时间相关指标比较无统计学差异.A、C组中上述指标比较均存在统计学差异,与未非随机分组相关.四组手术后未出现大出血及感染相关并发症,B、C两组各出现1例导管异位情况.结论 带涤纶套中央静脉导管置入方法推荐首选经典撕脱鞘置管,该方法安全成功率高,术后并发症少.其次是颈内静脉切开置管,通过引导钢丝逐层扩张后置管适用于皮下组织疏松、脂肪层少的患者.而颈内静脉切开方法置管是在没有超声学指引下临床穿刺失败后的补救方法,但该方法技术要求高,手术风险大,故临床不作为首选.

Objectives To Observe the four different methods of cuffed central venous catheter and clinical analysis.Methods All 132 patients underwent cuffed central venous catheterization,who were divided into group A （36 cases） of the avulsed sheath placement cuffed central venous catheter,group B （36 cases） of external jugular vein placed catheter,group C （32 cases） of placement catheter directly by direction of wire and after expansion layer by layer and group D （28 cases） of internal jugular vein incision.Results There were no significant differences in creatinine,urea nitrogen level before and after dialysis of four groups and urea clearance index were both standard.There were no the significant differences in blood flow,blood return venous pressure,urea clearance index and catheter retention time of three groups（group A、B、D）.There were no significant differences in above index of group A、C.There were no bleeding and infection related complications in four groups after operation,but one case of catheter ectopic occurrence in group B and group C.Conclusions Classic avulsion sheath catheter method is as the preferred for cuffed catheter central venous catheter insert method,and it is a safe and high successful method with less complications.The second method is the internal jugular vein catheter incision,through the guide wire and expansion layer by layer placed catheter,it is suitable for patients with loose subcutaneous tissue,less fat layer.The internal jugular vein incision method in the cuffed central venous catheter is the remedy method for clinical puncture failure without ultrasonic guide,but this method is needed higher technology with high operation risk,not as the clinical first choice.