尿毒症患者血液透析导管插入深度的预估及最佳通径的选择

Estimation of the insertion depth of hemodialysis catheter in uremia patients and selection of the best diameter

目的选择尿毒症患者透析导管插入深度的预估方法以及最佳尺寸通径。方法评估了两种在胸部X光检查(CXR)上预估透析导管插入深度以及根据插入深度选择最佳导管尺寸的方法。方法一:58例患者在术前胸部X光检查上计算从预期的静脉头部(Cavoatrial结下方3.5 cm)到预定的皮肤穿刺点(右侧锁骨上方1.5 cm)的距离作为预估导管插入深度;方法二:54例患者通过将皮肤穿刺点与锁骨上缘之间的长度和锁骨上缘至预设静脉头部的长度相加得到预期导管插入深度。都采用术后胸部X光检查计算Cavoatrial结至动脉头部的距离。结果Cavoatrial结至动脉头部的距离分别为(12.106±7.96)、(11.33±3.19)mm。结论这两种方法均可很好地预测尿毒症患者血液透析导管插入深度并选择最佳尺寸通径。

Objective To choose the best method to estimate the depth of dialysis catheter insertion in uremia patients.Methods Two methods used to estimate the insertion depth dialysis catheters and select the optimal size of dialysis catheter were evaluated with Chest X-ray(CXR).In method 1(58 patients),the depth was estimated by calculating the distance from the expected vein tip(3.5 cm below the cavoatrial junction)to the predetermined skin puncture point(1.5 cm above the right collarbone).In method 2(54 patients),the depth was estimated by pulling the distance from the puncture point to supraclavicular edge and from the superior border of clavicle to the expected vein tip together.Postoperative Chest X-ray was used to calculate the distance between the cavoatrial junction and artery tips.Results The average distance between the cavoatrial junction and arterial tip was(12.106±7.96)mm,(11.332±3.19)mm,respectively.Conclusions Both methods can predict the depth of hemodialysis catheter insertion in uremia patients and select the optimal size of dialysis catheter.