纤维鞘皮下段在中心静脉再置管中的利用价值

The application of fibrous sheath subcutaneous segment in central vein recatheterization

目的研究纤维鞘皮下段在特定透析患者中心静脉再置管中应用的可行性及安全性。方法回顾武汉市第一医院血液透析中心2012年9月至2019年6月间因导管脱落等原因再置入血液透析导管的特定透析患者21例,对其病例资料进行统计分析。结果纳入的21例患者中,男性7例,女性14例,平均年龄(65.9±15.8)岁,平均透析龄(27.7±24.0)个月。再次置管原因包括导管完全脱落11例,导管相关性血流感染患者6例,长期导管完全堵塞失功2例,另有2例导管换管时异位穿刺不成功。21例患者中20例(95.2%)手术取得成功,1例(4.8%)换管失败改行股静脉长期导管手术。换管成功患者术后X线片复查导管位置正常。新置入导管透析中泵控血流量均在250 mL/min及以上。患者均未出现严重并发症。结论该经原血液透析导管纤维鞘皮下段原位再置入新血液透析导管的手术方法,经济安全,成功率高,并发症少,可作为原位导丝更换导管和异位穿刺更换导管等换管方法的有益补充。

Objective To study the feasibility and safety of application of fibrous subcutaneous segment in central vein recatheterization in selected patients.Methods A retrospective analysis was conducted for a total of 21 selected patients who underwent recatheterization through the fibrous sheath subcutaneous segment of the previous hemodialysis catheter due to catheter fall-off or other reasons,from September 2012 to June 2019,and their case data were statistically analyzed.Results A total of 21 patients were collected,including 7 males and 14 females,with an average age of(65.9±15.8) years and an average dialysis age of(27.7±24.0) months.The reasons for recatheterization included complete catheter fall-off in 11 cases,catheter-related bloodstream infection in 6 cases,long-term complete hemodialysis catheter blockage in 2 cases,and unsuccessful ectopic catheter puncture in 2 cases.Of the 21 patients,20(95.2%) achieved successful recatheterization,and 1(4.8%) underwent long-term catheterization of femoral vein after failure.In patients with successful,the X-ray examination indicated that the catheter was in good position.All the above patients’ pumping control blood flow in hemodialysis after recatheterization was equal to or greater than 250 mL/min.There were no serious complications in this group.Conclusions In situ recatheterization of hemodialysis catheter through the fibrous sheath subcutaneous segment of previous hemodialysis catheter is an economical and safe method with a high success rate and few complications,and may be used as a helpful supplement for in situ catheter replacement through a guidewire and catheter replacement through ectopic catheter puncture.