2条生命线的困境：起搏器和透析导管  

Dilemma of double lifelines: pacemaker and tunnel-cuffed catheter

作　　者：侯西彬[1] 杨涛[1] 余阳[2] 詹申 任树风[1] 王玉柱[1] HOU Xi-bin;YANG Tao;YU Yang;ZHAN Shen;REN Shu- feng;WANG Yu-zhu(Beijing Haidian Hospital (Haidian District,Third Hospital,Beijing University),Beijing 100080;Department of Cardiology,Haidian Hospital (Haidian Section of Peking University Third Hospital),Beijing 100080,China)

机构地区：[1]北京市海淀医院(北京大学第三医院海淀院区)肾内科,北京100080 [2]北京市海淀医院(北京大学第三医院海淀院区)肾内科,北京100080

出　　处：《中国血液净化》2019年第11期772-775,共4页Chinese Journal of Blood Purification

摘　　要：目的探讨存在起搏器导线的情况下置入颈内静脉带涤纶套透析导管以及两者共存是否具有可行性。方法选取2014年4月~2018年8月北京市海淀医院肾内科存在起搏器导线患者数字减影血管造影(digital subtraction angiography,DSA)下置入带涤纶套透析导管病例17例,观察术中及术后起搏器电极、导线有无移位,起搏器功能有无异常。随访期间观察透析导管、起搏器导线感染发生率、症状性静脉高压征发生率以及拔除导管时是否发生导管嵌顿。结果17例患者中,15例导管尖端顺利进入右心房中上部,1例球囊扩张上腔静脉狭窄后置入导管,1例导管置入过程中顶在起搏器导线上,经调整方向后导管尖端顺利进入右心房中上部。术中及术后起搏器电极、导线无移位,起搏器功能无异常;随访期间所有患者均未出现起搏器导线感染及起搏器功能不良。1例在置管1年后出现导管相关性感染,予以抗感染治疗及更换导管后好转,起搏器导线未受到感染。1例出现置管侧上肢轻度肿胀,但不需要临床干预。原位更换导管9例,拔除原导管时均未发生导管嵌顿。结论存在起搏器导线的情况下,如无重度血管狭窄,DSA下置入带涤纶套透析导管成功率高、安全可行,两者共存短期内未见起搏器导线感染及起搏器功能不良,很少出现症状性静脉高压征。Objective To explore the feasibility of implanting tunneled cuffed catheter (TCC) through internal jugular vein in the presence of heart pacemaker leads and the co-existence of catheters and leads. Methods Seventeen patients with pacemaker leads were recruited from the Department of Nephrology, Beijing Haidian Hospital from April 2014 to August 2018. TCCs were implanted under digital subtraction angiography (DSA) for these patients. The position of pacemaker electrode and leads and the function of pacemaker were examined during and after the operation. The infection around catheter and pacemaker lead, the symptomatic venous hypertension, and the ease of catheter removal were observed during the follow- up period. Results In the 17 patients, the tips of the catheters were successfully placed in the upper-middle part of right atrium in 15 patients, the catheter was implanted after balloon dilatation of the superior vena cava stenosis in one patient, and the catheter tip was first bumped the pacemaker wire and then arrived to upper-middle part of right atrium after adjustment of the tip direction in one patient. During and after the operation, the pacemaker electrodes and leads were not displaced and the functions of the pacemakers were normal. There were no pacemaker lead infection and pacemaker dysfunction during the follow-up period. One patient developed catheterrelated infection after the catheterization for one year but without infection of the pacemaker leads;the infection was cured after anti- infective therapy and replacement of the catheter. Mild swelling of upper limb occurred in one case, but no clinical intervention was required. The catheters were replaced in situ in 9 cases, and no catheter got stuck during removal of the original catheters. Conclusions In patients with pacemaker leads but without severe vascular stenosis, the implanting of TCC under DSA was highly successful and safe. The coexistence of catheters and pacemaker leads did not cause infection around pacemaker lead and pacemaker dysfunct

关 键 词：血液透析 起搏器导线 带涤纶套透析导管 症状性静脉高压征 导管相关性感染 

分 类 号：R318.16[医药卫生—生物医学工程]