摘要
目的对比不同年龄段维持性血液透析患者颈内静脉隧道式cuff导管的置管情况及应用效果,评估颈内静脉隧道式cuff导管在老年患者中的应用安全性与有效性。方法选择海军总医院使用颈内静脉隧道式cuff导管的240例终末期肾病患者,运用Seldinger技术留置颈内静脉隧道式cuff导管,进行维持性血液透析,根据年龄是否大于65岁分为A、B两组,分别观察患者置管后管路末端位置、导管功能不良发生率、导管正常使用的比例、停止使用的原因及导管使用的常见并发症,并进行统计学处理。结果 A、B组所有患者的导管置入后均能够正常使用,血流量均达到250～500 ml/min。颈内静脉隧道式cuff导管平均留置16.3个月,最长41个月,最短4个月;2组插管在左、右侧颈内静脉入路选择上存在差异(P<0.05);2组导管功能不良的发生率差异无显著性;2组导管正常使用比例的差异(P=0.265)及停止使用比例的差异(P=0.296)无显著性。A、B组发生出血、导管血流不畅、感染等并发症的患者均较少,经处理后隧道式cuff导管均可正常使用。结论对于血管条件不良、无法建立内瘘而又需要进行维持性血液透析的患者,应用颈内静脉隧道式cuff导管可以满足透析充分性,对于老年患者是一种安全有效的选择。
Objective To contrast the catheterization and application of internal jugular vein cuffed-tunneled catheters in hemodialysis（HD） patients at different ages,and to evaluate the safety and effectiveness of the application of internal jugular vein cuffed-tunneled catheters in elderly patients. Methods The internal jugular vein cuffed-tunneled catheters were inserted to 240 patients with end stage renal disease in navy general hospital to perform hemodialysis by using Seldinger technique. According to whether the age is more than 6 5 years old, the patients were divided into group A and B. The end position of the catheters,the incidence of the dysfunction of the catheter, the proportion of the normal use of the catheter,the reasons for the stopping use of the catheter and the common complications of the catheterization were observed, and the statistical treatment was performed.Results All catheters of group A and B can be used normally and the blood flow was 25 0-5 00 ml/min. The average survival of the internal jugular vein cuffed-tunneled catheters was 16.3 months,the longest was 4 1 months and the shortest was 4 months. There is a statistical difference between the two groups of intubation on the left and right internal jugular vein approach（P〈0.05）. The dysfunction rates between two groups were not different. The proportions of normal use and disuse between two groups were not different（P=0.265 and P=0.296）. Patients of group A and B with bleeding,catheter blockage,infection and other complications were less,and the catheters can be used normally after treatment. Conclusions For some HD patients with difficulty in establishing the A-V fistula,the internal jugular vein cuffed-tunneled catheter can achieve dialysis adequacy and is a safe and effective choice for elderly patients.
作者
肖枫林
王圣元
张志勇
余永武
李明旭
XIAO Feng-lin;WANG Sheng-yuan;ZHANG Zhi-yong;YU Yong-wu;LI Ming-xu(Department of Nephrology,Navy General Hospital of China People＇s Liberation Army,Beijing 100048,China)
出处
《临床肾脏病杂志》
2018年第8期484-487,共4页
Journal Of Clinical Nephrology
关键词
颈内静脉置管术
隧道式cuff导管
血液透析
Internal jugular vein catheterization
Cuffed.tunneled catheter
Hemodialysis
