数字减影血管造影技术引导在长期血液透析导管置管的应用价值  

Application value of guidance by digital subtraction angiography for implantation of long-term indwelling hemodialysis catheter

作　　者：李明[1] 敖华[2] 陈文祥[2] 张秋玲[2] 李传红[2] 刘万红[1] 

机构地区：[1]武汉大学基础医学院,武汉430071 [2]三峡大学第三临床医学院.葛洲坝中心医院

出　　处：《内科急危重症杂志》2015年第5期341-343,共3页Journal of Critical Care In Internal Medicine

摘　　要：目的：探讨数字减影血管造影技术（DSA）引导在长期血液透析导管置管的应用价值。方法：收集常规盲穿及超声引导下长期透析导管置管失败患者64例。采用DSA技术,通过造影剂观察血管情况,标定体表标识指导穿刺血管,必要时立即进行溶栓、球囊扩张等辅助手段协助长期透析导管植入,确保导管达到满意的位置,满足透析需要。并对置管失败的相关因素进行分析。结果：64例在DSA可视下置管,全部成功,首次穿刺成功率高达95%（61例）。所有患者术后透析时导管血流量均在200～280 mL/min,未出现导管功能不良及感染等。结论：DSA引导下颈内静脉穿刺置管术能显著提高置管成功率,可作为传统盲穿法及超声引导下颈内静脉置管困难患者的补救措施。Objective： To explore the application value of digital subtraction angiography（ DSA） guided in long-term indwelling catheter implantation for hemodialysis. Methods： Sixty-four losers after conventional blind and ultrasound-guided puncture were collected. Surface marker of puncture blood vessel was identified with help of DSA technique. We used thrombolysis and balloon expansion technique to assist the implantation of long-term indwelling catheter if necessary until the catheter located in a proper position and fitted to the needs of dialysis. The related factors of failure in indwelling catheter implantation were analyzed. Results： The success rate achieved 100% by DSA visualization catheter in these 64 losers. Success rate at first puncture was as high as 95%（ 61 cases）. The blood flow reached 200 ～ 280 mL / min in all these patients after intervention,and no catheter dysfunction and infection occurred. Conclusions： DSA-guided internal jugular vein catheterization can notably raise its success rate,and achieve good clinical effect,which can be used as a remedial measure for those difficult to be achieved by traditional methods.

关 键 词：数字减影血管造影技术 血液透析 血管通路 双腔血液透析导管 

分 类 号：R459.5[医药卫生—治疗学]