带隧道和涤纶套透析导管功能不良的介入处理策略  

Intervention treatment strategy for dysfunction of tunnel-cuffed catheter

作　　者：陈卓[1] 袁瑞凡[1] 金杰[1] 黄华星[2] 沈良兰[2] 丁文彬[1] CHEN Zhuo;YUAN Rui-fan;JIN Jie;HUANG Hua-xing;SHEN Liang-lan;DING Wen-bin(Department of Intervention Radiology;Department of Nephrology,The Second Affiliated Hospital of Nantong University,Nantong,Jiangsu 226001)

机构地区：[1]南通大学第二附属医院介入科 [2]南通大学第二附属医院肾内科,江苏南通226001

出　　处：《赣南医学院学报》2023年第9期966-970,共5页JOURNAL OF GANNAN MEDICAL UNIVERSITY

摘　　要：目的:探讨带隧道和涤纶套透析导管(Tunnel-cuffed catheter,TCC)功能不良的不同情形及相应介入处理策略。方法:回顾分析2014年12月至2021年12月在南通大学第二附属医院肾内科、介入科治疗的38例TCC导管功能不良患者,分别采用溶栓治疗、单纯更换导管、球囊扩张成形后换管、圈套剥离导管头端纤维蛋白鞘、股静脉置管法处理后的临床疗效。结果:9例患者溶栓治疗后7例血流直接获得改善。21例患者(包括2例溶栓治疗后血流未改善患者)经单纯换管后透析导管均正常使用。6例患者经球囊扩张成形后换管5例疗效满意,仅1例3个月出现动脉端血流不足。2例患者经圈套剥离导管头端纤维蛋白鞘后透析导管正常使用。2例患者因已无换管条件予股静脉置管。结论:TCC导管功能不良需造影评估,分析功能不良的具体情形,采用合理的介入方式处理,尽可能在同一通路上维持更长的使用时间,延长患者透析时间。Objective:To explore the different conditions leading to the dysfunction of tunnel-cuffed catheter(TCC)catheter and the intervention treatment strategies.Methods:The clinical effects of 38 patients with TCC catheter dysfunction treated in the Department of Nephrology and the Department of Intervention of the Second Affiliated Hospital of Nantong University from December 2014 to December 2021 were retrospectively analyzed.They were treated with thrombolytic therapy,simple catheter replacement,catheter replacement after balloon dilatation,decorting the fibrin sheath at the head of the catheter,and catheter replacement through femoral vein.Results:After thrombolytic therapy in 9 patients with TCC catheter dysfunction,the blood flow of 7 patients was improved.The dialysis catheter of 21 patients returned to normal after tube replacement(including 2 cases with no improvement in blood flow after thrombolytic therapy).Six patients underwent balloon dilatation and tube replacement.Five of them had satisfactory results,and only one patient had insufficient blood flow at the end of the artery within 3 months.The dialysis catheter returned to normal in 2 patients after the fibrin sheath at the tip of the catheter was stripped by the snare.Two patients received femoral vein catheterization because there was no condition for tube replacement.Conclusion:TCC catheter dysfunction needs angiography evaluation.Analyze the causes of catheter dysfunction and adopt reasonable intervention methods.It can maintain a longer use time on the same vascular access as far as possible and prolong the patient dialysis time.

关 键 词：透析导管 导管功能不良 血管通路 介入 

分 类 号：R318.16[医药卫生—生物医学工程]