DSA导引超滑加硬导丝更换失功能颈内静脉隧道式Cuff透析导管临床应用  

Clinical application of super-slippery and hard guide wire in DSA-guided replacement of disfunctional internal jugular vein tunnel-type Cuff dialysis catheter

作　　者：曹莉明[1] 张勇学 何景良[1] 李亮[1] 崔进国[1] 陈静[1] 谢永伟 梁志会[1] CAO Liming;ZHANG Yongrue;HE Jingliang;LI Liang;CUI Jinguo;CHEN Jing;XIE Yongvei;LIANG Zhihui(Department of Interventional Therapy,No.980 Hospital of PLA Joint Logistics Support Forces,Shjiazhuang,Hebei Prorince 050082,China)

机构地区：[1]联勤保障部队第九八〇医院(白求恩国际和平医院)介入治疗科,河北石家庄050082

出　　处：《介入放射学杂志》2023年第4期363-365,共3页Journal of Interventional Radiology

基　　金：河北省医学科学研究重点课题项目(20211761)。

摘　　要：目的 探讨DSA导引下应用超滑加硬导丝一步式介入技术实施颈内静脉隧道式Cuff血液透析导管原位更换的安全性和有效性。方法 回顾性分析2016年1月至2021年1月在解放军第九八〇医院接受诊治的20例经右颈内静脉植入隧道式Cuff透析导管后失功能或移位的慢性肾功能不全患者临床资料,其中男12例,女8例,中位年龄58岁,均在DSA导引下经超滑加硬导丝更换透析导管。评价手术成功率、透析导管通畅率及并发症发生率。结果 20例患者中18例为导管功能不良,经超声或造影确诊为导管内血栓形成,抗凝和溶栓治疗无效;2例为导管移位至颈内静脉。所有患者均于原位成功完成透析管更换,透析导管血流量由术前(135.5±30.8) mL/min显著改善为术后(265.8±25.6) mL/min,差异有统计学意义(P<0.05)。术中除局部疼痛外,未发生纵隔血肿、气胸等并发症。随访6个月,透析导管通畅率为100%,无导管功能不良、移位及感染等发生。结论 DSA导引超滑加硬导丝一步式介入技术更换颈内静脉隧道式Cuff血液透析导管安全有效,值得临床推广。Objective To investigate the safety and effectiveness of one-step intervention technology by using super-slippery and hard guide wire in DSA-guided in situ replacement of disfunctional internal jugular vein tunnel-type Cuff dialysis catheter. Methods The clinical data of 20 patients with chronic renal insufficiency, who received implantation of the tunnel Cuff dialysis catheter via the right internal jugular vein access between January 2016 and January 2021 at the No.980 Hospital of PLA Joint Logistics Support Forces of China, were retrospectively analyzed. The patients included 12 males and 8 females, with a median age of58 years. DSA-guided replacement of dialysis catheter by using super-slippery and hard guide wire was performed in all patients. The success rate of surgery, the patency rate of dialysis catheter and the incidence of complications were evaluated. Results Among the 20 patients, 18 patients had disfunctional dialysis catheter,including ultrasound-proved or radiography-confirmed intra-catheter thrombosis formation which showed no response to anticoagulation and thrombolytic therapy, and 2 patients developed catheter displacement into the internal jugular vein. Successful in situ replacement of dialysis catheter was accomplished in all the 20patients. The blood flow in dialysis catheter was significantly increased from preoperative(135.5±30.8) mL/min to postoperative(265.8±25.6) mL/min, the difference was statistically significant(P<0.05). Except local pain,no serious complications such as mediastinal hematoma, pneumothorax, etc. occurred. The patients were followed up for 6 months, the patency rate of dialysis catheter was 100%, and no dysfunction, displacement or infection of catheter occurred. Conclusion In carrying out DSA-guided in situ replacement of disfunctional internal jugular vein tunnel-type Cuff dialysis catheter, the use of one-step intervention technology with superslippery and hard guide wire is clinically safe and effective. Therefore, this technique is worth popularizing in clini

关 键 词：慢性肾功能不全 血液透析 介入干预 导丝 透析导管 

分 类 号：R472[医药卫生—护理学]