1598例经颈内静脉带隧道中心静脉导管置入术分析  

Analysis of tunneled central venous catheterization through internal jugular vein in 1,598 cases

作　　者：崔锐[1] 郑欣 杨涛[1] 侯西彬[1] 王玉柱[1] 詹申 CUI Rui;ZHENG Xin;YANG Tao;HOU Xi-bin;WANG Yu-zhu;ZHAN Shen(Department of Nephrology,Beijing Haidian Hospital,Beijing 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

出　　处：《中国血液净化》2021年第2期122-126,共5页Chinese Journal of Blood Purification

摘　　要：目的探讨颈内静脉入路的带隧道中心静脉导管置管准确性和安全性的影响因素。方法回顾性分析2011年~2019年行颈内静脉带隧道中心静脉导管置入术的病例资料。收集人口学资料,手术相关资料,包括置管位置,是否用X线,置管失败原因,介入干预情况,干预失败原因等。研究主要终点是置管成功率和失败原因。结果1598例患者纳入分析,平均年龄(63.27±11.86)岁,男性659例(41.2%),X线使用率34.7%。总的置管成功率为95.4%(1525/1598),用X线和未用X线的置管成功率为97.8%比94.2%(χ^(2)=11.292,P=0.001)。总体患者经右颈内静脉置管比经左颈内静脉置管的成功率高(96.6%比90.1%,χ^(2)=22,375,P<0.001);未用X线时,经右颈内静脉置管成功率高于经左颈内静脉(χ^(2)=56,871,P<0.001);应用X线后,经右颈内静脉和经左颈内静脉置管成功率无明显差异(χ^(2)=1.424,P=0.233)。置管失败原因有导管尖端异位(包括导管尖端血管内异位和血管外异位)、非X线下导丝置入受阻、介入开通中心静脉失败。导管尖端异位病例均未用X线,占未用X线人群的3.3%(34/1043);未用X线,导丝置入受阻置管失败27例;介入干预病例237例,成功置管225例,未开通中心静脉置管失败12例。多因素logistic回归分析显示,经左颈内静脉置管(OR=1.700,95%CI:3.203~9.362,P<0.001)和未用X线置管(OR=1.653,95%CI:2.650~10.28,P<0.001)是颈内静脉置管失败的独立危险因素。结论X线的应用可以增加经颈内静脉置入带隧道中心静脉导管的成功率,经左颈内静脉置管与经右侧颈内静脉置管相比,应用X线获益更明显。Objectives To explore the factors relating to success and safety of tunneled central venous catheterization via internal jugular vein.Methods We conducted a retrospective study on patients undergoing tunneled central venous catheterization via internal jugular vein during 2011 to 2019.Demographic information and operation-related data,including location of the catheter,utilization of X-ray examination,cause of catheterization failure,intervention method,cause of intervention failure,and many others were recruited.The main termination point of the study was the rate of successful catheterization and the cause of catherization failure.Results A total of 1,598 patients were included in this study,with the average age of 63.27±11.86 years old,659 males(41.2%),and X-ray utilization rate of 34.7%.The overall rate of successful catheterization was 95.4%(1,525/1,598).The rates of successful catheterization with and without x-ray examination were 97.8%and 94.2%respectively(χ^(2)=11.292,P=0.001).The rate of successful catheterization via right internal jugular vein was higher than that via left internal jugular vein(96.6%vs.90.1%;χ^(2)=22,375,P<0.001).In the patients X-ray examination was not used,the rates of successful catheterization via right internal jugular vein and left internal jugular vein were 95.9%and 76.8%respectively(χ^(2)=56,871,P<0.001);while in the patients X-ray examination was used,the rates of successful catheterization via right and left jugular veins had no difference(98.4%vs.96.8%;χ^(2)=1.424,P=0.233).The causes of catheterization failure included ectopic tip of the catheter(endovascular ectopic or extravascular ectopic tip of the catheter),obstruction of guide wire insertion without the help of X-ray examination,and failure of interventional central vein opening.X-ray was not used in all ectopic catheter tip cases,accounting for 3.3%(34/1,043)of the patients without X-ray examination.In patients without X-ray examination,catheterization failure due to obstruction of guide wire insertion was foun

关 键 词：带隧道中心静脉导管 颈内静脉 血液透析 

分 类 号：R318.16[医药卫生—生物医学工程]