摘要
目的 :观察永久性双腔留置导管作为血透长期通路的效果 ,比较两种双腔留置导管的并发症。 方法 :我科 1998年 12月～ 2 0 0 0年 9月 ,行带涤纶套双腔深静脉留置导管手术 2 4例 ,年龄 30～ 81(平均 6 0 )岁 ,术前平均血透 30 6个月 ,平均内瘘 (和腹透置管 )手术 3 5次 ,留置通路经颈内、颈外或锁骨下静脉。随机观察临时性双腔留置导管 15例 ,颈内或锁骨下静脉留置 ,年龄 10～ 6 5 (平均 42 )岁。以尿素清除指数KT/V和UUR为透析效果的评价指标。 结果 :带涤纶套双腔留置导管经颈内静脉、颈外静脉和锁骨下静脉入路分别有 12例、8例和 4例 ,长期留置导管已使用 15 0个病人月 ,平均使用 6 5 (1～ 19)个月 ,使用长期导管血液透析共 1812例次。常见的并发症是 :导管内血栓形成或血流不畅 6例 84次 ,发生率为 2 3 %透析例次 ;发生感染 7例 12次 ,发生率为 1/12 5个病人月。1例置管后发生心律失常立即拔管 ,因肾移植成功拔管 2例 ,动脉端血流不畅拔管 1例 ,感染拔管 1例。 2 3例的平均KT/V达到 1 2 3,平均UUR为 6 8%。临时双腔导管平均留置 2个月后拔管 ,临时导管血透共 314例次 ,主要并发症为血流不畅 10例 2 5次 ,发生率为 8 0 %透析例次 ,感染 5例 ,1/6个病人月。 结论
Cuffed dual lumen catheter has been advocated as a permanent vascular access in maintenance hemodialysis(MHD)patients in whom a arterial venous fistula was proved difficult to establish.In this report,we described our experience with the application of cuffed dual lumen catheters(Permcath)and compared it with non cuffed dual lumen catheters in hmodialysis patients. METHODOLOGY ]Permanent vascular access with Permcath cuffed dual lumen catheter was estabished in 24 MHD patients who had been on hemodialysis for an average duration of 30 6 months.Placement of the catheter was carried out under local anesthesia with application of Seldinger technique by route of internal jugular vein(in 12 cases)or external jugular vein (in 8 cases)or subclavian vein(in 4 cases).The catheter related complications were observed over a mean period of 150 patients months,and were compared with those of non cuffed dual lumen catheter placed by route of internal jugular vein or subclavian vein(in 15 cases). RESULTS The placement of the Permcath dual lumen catheter were successful in all the 24 MHD patients. In 7 of the 24 cases,12 episodes of catheter related infection were observed during the observation,with an incidence of 12 5 patient months.Catheter related hematoma was observed in 2 of the 24 MHD patients.The catheter was removed in 5 cases,1 for arrhythmia immediately after cannulation,1 for uncontrolled infection after 17 months′ usage,1 for insufficient flow rate and 2 after successful renal transplantation.The non cuffed dual lumen catheters were maintained for a mean period of 2 months.With a obstruction rate of 8 0% and an infection rate of 6 patient months. CONCLUSION ]Cuffed dual cavity catheter is a preferred alternative for MHD patients whose vascular access is difficult to be established otherwise.Catheter related complications are significantly less than those of non cuffed catheter.
出处
《肾脏病与透析肾移植杂志》
CAS
CSCD
2000年第6期516-519,共4页
Chinese Journal of Nephrology,Dialysis & Transplantation
