超声引导下改进的长期血透导管置入术的临床应用及其关键操作

Clinical application and key operation of improved long term hemodialysis catheter implantation under ultrasound guidance

目的:分析、研究在长期血透导管置入术中运用超声引导方式的操作方法及临床价值。方法:收治无法建立动静脉内瘘维持性血液透析患者60例,随机平分为两组。传统置管术组应用传统体表解剖标志经颈内静脉穿刺结合撕脱鞘进行置管。改进置管组采用B超引导下选择性经颈内静脉穿刺结合导引钢丝引导进行导管置入。结果:传统置管术患者穿刺失败8例,甚至出现误穿最终造成穿入颈内动脉,导致血肿问题的发生。出现10 m L以上出血情况5例,在手术后12 h内出现非常明显的穿刺点以及渗血12例。实施改进置管术的患者,无误穿情形的发生,出现10 m L以上的出血仅2例,手术24 h内出现出口出血的情况1例。实施改进置管术,患者在治疗中不会有明显的痛感,而且还能明显缩短手术的时间。结论:超声引导下改进的长期血透导管置入术在手术的操作过程中将更加方便和顺利,具有更高的安全性和耐受性,手术过程中出血的概率也很低。

Objective:To analyze and study the operation method and clinical value of ultrasound guided mode in long termhemodialysis catheter insertion.Methods:60 cases who were unable to establish arteriovenous internal fistula in maintenancehemodialysis were selected.They were randomly divided into the two groups on average.The traditional technique group usedtraditional body surface anatomy for internal jugular vein puncture combined with avulsion of the sheath tube.The improved settube group was taken selective percutaneous puncture of internal jugular vein guided by internal jugular vein guided byultrasound guided catheter insertion.Results:8 cases of puncture failure in patients with traditional catheterization,even wrongwear resulting into the internal carotid artery,causing the hematoma.There were more than 10 mL bleeding in 5 cases,in 12 hoursafter surgery,a very obvious puncture point and bleeding in 12 cases.There was no false puncture in patients who had undergoneimproved catheterization,and there were more than 10 mL of bleeding in only 2 cases,1 case of bleeding occurred within 24 h ofoperation.The implementation of improved catheterization in the treatment,patients would not have obvious pain,but alsosignificantly shorten the time of surgery.Conclusion:Under the guidance of ultrasound,the improvement of long term hemodialysiscatheter placement will be more convenient and smooth in the operation process,with a higher safety and tolerance.The probabilityof bleeding during surgery is also very little.