纤维鞘缺损处透析导管置入纠正透析导管功能不良效果观察

Tunneled dialysis catheter placement through fibrin sheath crevasse for the treatment of catheter dysfunction

目的 探索一种处理导管相关纤维鞘的新方法以改善透析患者的导管功能。方法 回顾40例因无法建立动静脉内瘘行中心静脉导管留置术后的维持性血液透析患者,经血管造影证实存在导管相关纤维鞘,同时纤维鞘存在缺损,造影剂经纤维鞘缺损处流出,头臂静脉和(或)上腔静脉造影剂显影良好。18例患者应用导丝引导透析导管经纤维鞘缺损处进入中心静脉,以避开原有纤维鞘对导管的包绕,将导管置入右心房。另22例患者应用原位导管更换的方法将导管置入右心房。结果 2组患者均在介入治疗术后次日应用导管透析,透析时血流量为250ml/min,分别随访3个月和6个月,3个月时2组患者透析血流量为(241±2.92)ml/min比(240±4.18)ml/min,Kt/V值为(1.3±0.05)比(1.28±0.04),2组相比差别没有统计学意义(P=0.420)。6个月时纤维鞘缺损处透析导管置换组透析流量和Kt/V值均高于原位透析导管更换组,分别为(202±3.74)ml/min比(240±4.47)ml/min(P=0.020)和(1.04±0.04)比(1.28±0.03)(P=0.010),2组相比差别有统计学意义。所有患者术中、术后均未出现严重并发症。结论 通过纤维鞘缺损处透析导管置入可以纠正导管功能不良,此方法安全、有效。

Objective To search for a new technique for the management of fibrin sheath in order to improve the treatment of catheter dysfunction in hemodialysis patients.Methods A retrospective analysis was conducted for the 40 hemodialysis patients who failed to establish arteriovenous fistula and underwent indwelling tunneled dialysis catheterization.They had catheter related fibrin sheath and fibrin sheath crevasse confirmed by DSA images that showed outflow of contrast through the fibrous sheath crevasse with normal images of brachiocephalic vein and/or superior vena cava.Catheters were inserted into right atrium via central vein through the fibrin sheath crevasse to avoid wrapping of the catheter by the fibrin sheath in 18 patients,and by means of in situ catheter change in 22 patients.Results After the catheter intervention,the catheters were used for blood access on the next day in both groups and the blood flow reached 250ml/min.After 3 months,the blood access volumes of the two groups were （241 ±2.92） ml/min and （240±4.18）ml/min,respectively,and the Kt/V values were （1.3±0.05 vs.1.28±0.04）,respectively,without statistical differences between the two groups （P=0.420）.After 6 months,blood access volumes in in situ catheter change group and in catheter replacement through fibrous sheath crevasse group were （202±3.74） ml/min and （240±4.47） ml/min,respectively （P=0.020）,and Kt/V values were （1.04±0.04） and 1.28±0.03,respectively （P=0.010）.No severe complications due to the catheter replacement occurred in all patients.Conclusion Dialysis catheter implantation through fibrous sheath crevasse can safely and effectively correct the dysfunction of dialysis catheter