腹膜透析二次置管的原因及对策  

Countermeasures for peritoneal dialysis retubation

作　　者：杨磊[1] 朱铁锤[1] 郭明好[1] 

机构地区：[1]新乡医学院第一附属医院肾病风湿科,河南卫辉453100

出　　处：《医学信息（手术学分册）》2008年第3期206-208,共3页Medical Information Operations Sciences Fascicule

摘　　要：目的探讨腹膜透析二次置管的原因和对策。方法对2001至2007年在我科行腹膜透析治疗的148例患者进行回顾性分析,对其中行二次置管的患者寻找原因和相应对策。对于网膜包裹者可行网膜部分切除手术;对于腹透管移位者注意置入时的体表定位,位置过高容易移位,再次置管时位置稍低对于网膜异常活跃者也容易移位,可采取腹透管荷包缝。结果148例患者中8例在腹透过程中出现腹透液引流不畅,经改变体位、通便、排空膀胱、肝素加生理盐水加压注射等处理48h后仍不能使透析管通畅,行二次置管,发生率5.4%。置入一周内发生5例,一周到半年内1例,一年后2例。原因大网膜包裹2例,皮下隧道内腹透管扭曲1例,腹透管移位2例,腹膜炎后堵管2例,自行拔除1例。结论腹膜透析中二次手术原因常见于网膜包裹、置入定位不当、纤维蛋白凝块堵管、腹膜炎后等,如果手术及透析中注意上述问题,可以避免腹膜透析二次置管。Objective To explore the reasons and countermeasures for peritoneal dialysis retubation. Methods From 2001 to 2007, there were 148 patients on peritoneal dialysis in our sections. Retrospective analysis was made to investigate their causes and countermeasures. Results Among the 148 cases on peritoneal dialysis, 8 cases appeared abdominal fluid drainage impeded in the process. By changing the body position, purgation, emptying the bladder, pressurized injection of heparin plus saline and so on, the dialysis tube was still obstructed after 48 hours. So two - time catheterization was done and the incidence was 5.4%. Five cases need two - time catheterization when the place-ment was done within a week, a week to six months with one case and one year later with two cases. In two cases,the tube was parceled by the omentum, the subcutaneous peritoneal dialysis tube tunnels was distorted in one case, perito-neal dialysis tube was displaced in two cases, the tube was plugged after peritonitis in two cases and the tube was extracted by himself in one case. Partial resection of the omentum is feasible when the tube was parceled by omentum ; for the patients whose peritoneal dialysis tube were displaced, we should pay attention to the surface location when inserting, excessive highly location was easily displaced, when the tube again for a slightly lower position was also easily shifted when the omentum was very active, peritoneal dialysis tube can be taken purse - string suture fixation below 3 cm at the peritoneum. When the second tube occurred after the peritonitis, we should strengthen the publicity and education of peritoneal dialysis, and make the sterile operation strictly. Conclusions Usually the reasons of peritoneal dialysis secondly are parceled by omentum, improper positioning when implantation, fibrin clot plug the pipeline, peritonitis etc. If the above problems could be noticed in the surgery and dialysis, the second peritoneal dialysis tube would be avoided.

关 键 词：腹膜透析 二次置管 

分 类 号：R692[医药卫生—泌尿科学]