DSA引导下经皮上腔静脉直接穿刺置入长期CVC的临床研究  

Clinical Observation of DSA-guided Percutaneous Superior Vena Cava Puncture and Long-term CVC Implantation

作　　者：李锦玉[1] 刘孝猛[1] 李萌[1] LI Jinyu;LIU Xiaomeng;LI Meng(Nephrology Department,Heilongjiang Provincial Hospital,Harbin Heilongjiang 150036,China)

机构地区：[1]黑龙江省医院肾脏内科,黑龙江哈尔滨150036

出　　处：《中国卫生标准管理》2022年第10期48-51,共4页China Health Standard Management

摘　　要：目的观察数字减影血管造影(digital subtraction angiography,DSA)引导下经皮上腔静脉穿刺建立血液透析长期通路的有效性和影响因素。方法选取于2019年1月—2021年3月在黑龙江省医院诊治并符合经皮上腔静脉穿刺长期中心静脉导管(central venous catheter,CVC)置入条件的终末期肾病患者25例,于术前对患者进行病史采集和术前检查,在数字减影血管造影引导下经皮上腔静脉穿刺并置入长期隧道式中心静脉导管。记录患者术中、术后的并发症、观察其血液透析充分性,并对患者术后6个月内的血管通路状况进行随访。结果25例患者均顺利经皮上腔静脉穿刺且成功置入长期隧道式中心静脉导管,术后25例终末期肾病患者均可充分透析,25例患者的平均透析血流量可达(265.4±14.6)mL/min,提示血管透析通路建立良好。术后25例患者伤口均愈合良好,未出现伤口感染等问题。随访期间因脑干出血出现患者死亡1例,其余患者未发现与留置导管相关的并发症或死亡。结论在数字减影血管造影引导下,经皮上腔静脉穿刺建立血液透析长期中心静脉通路具备有效性和安全性。Objective To observe the effectiveness and influencing factors of establishing long-term hemodialysis access through percutaneous superior vena cava puncture guided by digital subtraction angiography.Methods A total of 25 patients with end-stage renal disease who were diagnosed and treated in Heilongjiang Provincial Hospital from January 2019 to March 2021 and were eligible for percutaneous superior vena cava puncture to establish long-term central venous catheter indwelling conditions were selected.The patient's medical history was collected and treated before surgery.Percutaneous superior vena cava puncture under the guidance of digital subtraction angiography and insertion of a long-term tunnel deep vein indwelling catheter were carried.The intraoperative and postoperative complications of the patient were recorded,the adequacy of hemodialysis was observed,and the vascular access status of the patient was followed up within 6 month after the operation.Results A total of 25 patients were successfully percutaneously punctured by the superior vena cava and successfully inserted a longterm tunnel-type central venous catheter.After the operation,25 patients with end-stage renal disease were fully dialyzed,and the average dialysis blood flow of 25 patients reached(265.4±14.6)mL/min,indicating that the vascular dialysis pathway was well established.The wounds of 25 patients healed well after the operation,and there were no wound infections and other problems.During the follow-up period,1 patient died of brainstem hemorrhage,and no complications or death related to the indwelling catheter were found in the remaining patients.Conclusion Under the guidance of digital subtraction angiography,percutaneous superior vena cava puncture to establish long-term central venous access for hemodialysis is effective and safe.

关 键 词：终末期肾病 数字减影血管造影 上腔静脉穿刺 血液透析 CUFF导管 中心静脉置管 介入治疗 

分 类 号：R473[医药卫生—护理学]