数字减影血管造影下血液透析长期导管改良的临床应用  

Clinical application of modified long-term indewelling catheter under DSA in hemodialysis patient

作　　者：李星[1] 赵向阳[1] 李鹏飞[1] 张凤昌[2] 贺际宏[3] 彭强[3] 郭影丽[1] 李宏梅[1] 

机构地区：[1]大庆市人民医院肾内科,黑龙江大庆163310 [2]大庆市人民医院超声科,黑龙江大庆163310 [3]大庆市人民医院介入科,黑龙江大庆163310

出　　处：《中国医学装备》2017年第1期58-61,共4页China Medical Equipment

基　　金：大庆市指导性科技课题(szdy-2015-58)"DSA下带涤纶双腔血液透析导管置管的应用"

摘　　要：目的:探讨在数字减影血管造影技术(DSA)可视下血液透析长期导管留置建立方法及效果。方法:选取68例因自身动静脉条件差无法行动静脉内瘘术,或原动静脉内瘘不能维持血液透析而施行长期导管置管术的患者,所有患者均系终末期肾衰竭需长期维持血液透析治疗。按手术方式的不同,将68例患者分为传统手术组(10例)和改良手术组(58例),传统手术组采用传统的颈内静脉长期导管置管术,应用Seldinger技术结合撕脱鞘进行置管;改良手术组采用改进的颈内静脉长期置管术,应用导引钢丝引导进行导管置入。观察两种置管术的难易程度及术中及术后出血等情况。结果:传统手术组的患者中,4例因隧道皮下组织收缩不能一次性将导管涤纶套放置在皮下所需位置,7例术中发生出血(>10 ml),6例术后48 h内发生明显穿刺点或隧道出口渗血。改良手术组全部一次性将导管涤纶套放置在所需的位置,仅2例出现明显穿刺点或隧道出口出血。结论:在DSA下行带涤纶套长期导管置管具有定位准确、操作安全及调管方便等优点,两种置管术中改良手术组采用的改进颈内静脉长期置管术出血量小,安全效果更好。Objective： To investigate the modified method and the effect of establishing longterm catheter indwelling under DSA in hemodialysis. Methods： 68 patients were selected to treated with long-term catheter of polyester set in DSA, which were in the end stage of renal failure with long-term hemodialysis therapy. In these patients, some of them couldn＇t receive intra-arteriovenous fistula surgery because their arteriovenous were poor quality and others had treated with long-term catheter dwelling because their intra-arteriovenous fistula couldn＇t keep hemodialysis. 68 patients were divided into traditional surgery group and improved surgical group according to different operation methods. 10 cases of traditional surgery group were done with traditional long-term catheterization of internal jugular vein, and 58 cases of improved surgical group with improved long-term catheterization of internal jugular vein catheter. The traditional long-term catheterization was combined Seldinger technology with avulsion of the catheter sheath. The improved method was done by the guide wire. To observe series of operation result, such as the difficulty level, bleeding during and after operation. Results： In 10 traditional catheterization cases, 4 cases couldn＇t be placed catheter of polyester set under the skin at once because of the contraction of the subcutaneous tissue. 7 cases occurred bleeding above 10 ml during operation. In 6 cases, there was an obvious puncture point or tunnel outlet bleeding in 48 hours. Improved intubation patients all disposable catheter placement in the desired position at once. In only 2 cases, there was a significant puncture point or bleeding in the tunnel. Conclusion： With the help of DSA guidance, long-term catheterization can be performed accurately, safely and easily. By the improved method, the amount of bleeding is smaller, and the safety effect is better.

关 键 词：数字减影血管造影技术 双腔带Cuff长期留置导管 血液透析 改良 

分 类 号：R459.5[医药卫生—治疗学]