华西医学

华西医学

异位中心静脉穿刺再置管在纤维蛋白鞘相关透析导管功能障碍中的临床研究

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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。

ObjectiveTo evaluate the safety and efficacy of second central venous catheterization in tunnel cuffed dialysis catheter (TCC) dysfunction with fibrin sheath.MethodA 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.ResultsAll 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, and 1 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.ConclusionsWith 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.

关键词: 血液透析血管通路; 带隧道带涤纶套透析导管; 导管功能障碍; 导管纤维蛋白鞘; 微创介入治疗

Key words: Hemodialysis vascular access; Tunnel cuffed dialysis catheter; Catheter dysfunction; Fibrin sheath; Intervention radiology

引用本文: 张春乐, 金岚菲, 于洋, 崔天蕾, 付平. 异位中心静脉穿刺再置管在纤维蛋白鞘相关透析导管功能障碍中的临床研究. 华西医学, 2018, 33(7): 852-855. doi: 10.7507/1002-0179.201806113 复制

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