锁骨下穿刺静脉置管术在重型肝炎患者中的应用——附506例临床分析  

Clinical application of subclavian catheterization in severe hepatitis: a clinical analysis of 506 cases

作　　者：杨景毅 唐振祥 倪辉 冼永超 叶晓玲[2] 程书权 

机构地区：[1]桂林市第三人民医院,广西桂林541002 [2]桂林医学院研究生院,广西桂林541004

出　　处：《临床肝胆病杂志》2014年第7期670-673,共4页Journal of Clinical Hepatology

基　　金：广西壮族自治区卫生厅2013年科研立项课题(Z2013438);桂林市科研立项课题(20140120-9-1)

摘　　要：目的总结重型肝炎患者行锁骨下静脉穿刺置管术期间的并发症,探讨其安全性和处理方法。方法对桂林市第三人民医院2001年10月-2012年12月期间506例重型肝炎患者做双重血浆置换联合胆红素吸附(DPMAS)等非生物型人工肝手术前进行锁骨下静脉穿刺置管,严密观察记录术中、术后各种不良反应。结果本组穿刺成功492例(97.2%),发生相关并发症38例(7.5%),其中穿刺点局部血肿/出血不止15例,导管感染13例,误入锁骨下动脉10例。结论锁骨下静脉穿刺术穿刺成功率高,可充分保障临床抢救与治疗需要,多数并发症经对症处理后不影响治疗。锁骨下静脉穿刺置管术可安全地应用于有凝血机制障碍的重型肝炎患者。Objective To summarize the complications of subclavian catheterization in severe hepatitis patients and to investigate clinical safety and treatment. Methods Five hundred and six cases of severe hepatitis, who underwent subclavian catheterization before non-bio-artificial liver operation like double plasma molecular adsorption system, were enrolled. Intraoperative and postoperative adverse reactions were under close observation and recording. Results Of all patients, 492 （97.2%） were punctured and catheterized successfully, and 38 （7.5%） developed complications, including local hematoma and bleeding at puncture sites （ 15 cases） , catheter infection （ 13 cases） , and catheterization into the subclavian artery （10 cases）. Conclusion Subclavian catheterization has a high success rate, and is sufficient to meet the need of clinical rescue and treatment. Most complications would not interfere with treatment outcome after proper disposal. Subclavian catheterization can be safely applied to severe hepatitis patients with coagulation disturbance.

关 键 词：肝功能衰竭 导管插入术 外周 导管 留置 手术中并发症 手术后并发症 

分 类 号：R657.3[医药卫生—外科学]