摘要
目的评价经皮下隧道深静脉留置带涤纶环套导管建立长期血液透析通路的效果。方法采用Seldinger技术穿刺深静脉,然后根据颈内静脉和锁骨下静脉双腔留置导管在体表投影确定皮下隧道位置,并应尽量使导管柔和弯曲以避免导管扭曲折叠。用隧道针将导管引入穿刺部位,涤纶环距离皮肤出口位置要在3cm以上。依次将软硬扩张导管顺导丝插入深静脉内,最后留置导管通过撕脱型外套送入血管。结果共计65例患者,其中颈内静脉带涤纶环双腔导管插入术58例,锁骨下静脉5例,股静脉2例。导管平均使用时间为(6.3±4.2)月,最长时间为38月。21例患者因栓塞拔管,8例患者因感染拔管,14例患者虽导管通畅,但患者因原发病等原因死亡,4例患者接受肾移植,12例患者仍然继续应用该导管透析。结论深静脉留置带涤纶环套导管可长期保留,感染率低,栓塞率低,可满足透析要求,适合于用传统方法无法建立长期透析通路的患者和准备近期行肾移植的患者。
Objective To evaluate the effects of cuffed catheter as the permanent hemodialysis access. Methods The standard Seldinger technique was used for guidewire insertion in the central vein. The tunnel was designed according to the transfer signs of the vein. In choosing the catheter exit site, it was also important to keep in mind that the final subcutaneous position of the catheter would take on a gentle bend to avoid any kinking of the catheter. Using a standard tunneling device, the cuffed catheter was pulled through subcutaneously up to the entrance of the guidewire, until the Dacron cuff of the catheter was placed subcutaneously at least 1.0 cm beyond the exit site. Soft and hard dilator was then placed over the guidewire and the cuffed catheter was then inserted through the peel-away sheath. Results The operation were performed in 65 patients. Among them, 59 patients were inserted through right internal jugular veins, 8 patients through right subclavian veins and 2 patients through femoral veins. The average using time were (6.3±4.2) months, the longest time were 38 months. The catheter functions were lost due to thrombosis (21/65)and infection (8/65). There were 14 patients died of uremia complications and 4 patients received renal transplantation with normal catheter function. Twelve patients were still using the cuffed catheters at the end of the investigation.Conclusion The cuffed catheter hemodialysis access can be kept for using for a relative long time with low rate of infection and thrombosis and is a good choice for the patients who can not use the traditional method to set up vascular access and the patients who prepare to receive renal transplantation.
出处
《中国血液净化》
2005年第5期249-251,共3页
Chinese Journal of Blood Purification
