摘要
目的评价异位中心静脉穿刺留置带隧道带涤纶套透析导管(tunnel cuffed dialysis catheter,TCC)治疗导管功能障碍合并导管纤维蛋白鞘的有效性与安全性。方法选取2016年6月—2017年6月于四川大学华西医院就诊发现导管功能障碍伴有纤维蛋白鞘重新异位中心静脉穿刺留置TCC的维持性血液透析患者14例。记录手术及术中并发症情况。结果 14例患者均成功异位静脉重新穿刺留置TCC,技术成功率100%,其中右颈内静脉穿刺2例,右颈外静脉穿刺1例,右无名静脉穿刺7例,上腔静脉穿刺4例。所有患者术后均未出现气胸、血胸、静脉撕裂、心包填塞等严重并发症。在随访期间,有2例患者出现导管功能障碍,分别给予尿激酶封管与原位TCC更换术好转;余患者未出现导管功能障碍及导管相关性感染。结论随着终末期肾脏病患者血管通路的建立与维护愈发困难,中心静脉资源的保护显得尤为重要。对于长期透析导管功能障碍合并导管纤维鞘的患者,基于经皮无名静脉或上腔静脉穿刺技术行异位中心静脉穿刺置入TCC,为疑难血管通路患者再次建立生命线的一种安全有效的方法。
Objective To evaluate the safety and efficacy of second central venous catheterization in tunnel cuffed dialysis catheter（TCC） dysfunction with fibrin sheath. Method A total of 14 maintenance hemodialysis patients who required second central venous catheterization were enrolled in West China Hospital of Sichuan University from June 2016 to June 2017 and the clinical information and procedure-related complications were recorded. Results All of the 14 patients were successfully performed with second central venous catheterization, of whom 4 cases had superior vena cava cannulation, 7 cases had right brachiocephalic vein cannulation, 2 cases had internal jugular vein cannulation, and1 case had external jugular vein cannulation. No procedure-related major complication occurred. During the follow-up,catheter malfunction occurred in 2 cases, which improved by urokinase seal and catheter change, respectively. The rest patients＇ catheter function remained normal. Conclusions With increasing difficult to construction and maintenance of vascular access, preservation of central vein resource is of high importance. For patients with TCC dysfunction with fibrin sheath, second central venous catheterization based on percutaneous brachiocephalic vein or superior vena cava cannulation is a safe and effective method to establish the lifeline for hemodialysis patients.
作者
张春乐
金岚菲
于洋
崔天蕾
付平
ZHANG Chunle;JIN Lanfei;YU Yang;CUI Tianlei;FU Ping(Kidney Research Institute,West China Hospital,Sichuan University,Chengdu,Sichuan 610041,P.R.China;Department of Gastroenterology,Suining Central Hospital,Suining,Sichuan 629000,P.R.China;West China School of Public Health,Sichuan University,Chengdu,Sichuan 610041,P.R.China;Department of Nephrology,West China Hospital,Sichuan University,Chengdu,Sichuan 610041,P.R.China)
出处
《华西医学》
CAS
2018年第7期852-855,共4页
West China Medical Journal
基金
四川省科技计划项目(2014SZ0095)
作者简介
通信作者：崔天蕾，Email：tianleicui@163．com
