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1、·72·中国血液净化2006年2月第5卷第2期ChineseJournalofBloodPurification,February12,2006,Vol.5,No.2·论著·深静脉置管行血液净化治疗临床病例分析张涤华郑智华许元文李广然郑勋华黄锋先吴培根沈清瑞余学清【摘要】目的总结血液净化治疗患者留置临时性中心静脉导管的经验,探讨中心静脉留置导管在血液净化治疗中的应用以及中心静脉留置导管并发症的防治。方法2004年2月～2005年6月,中山大学附属第一医院肾内科行临时性单针双腔静脉导管留置术血液净化治疗病例223例,其中颈内静脉置管193例（右181例，左1
2、2例），右锁骨下静脉置管21例，股静脉置管9例（右8例，左1例）。分析不同置管方法临床并发症的发生率及处理方法。结果置管术中的常见并发症有:误穿动脉8例(3.6%),皮下血肿10例(4.5%),穿刺部位渗血3例(1.3%)。置管术常见远期并发症有：导管相关感染28例(12.6%),导管栓塞9例(4.0%)，导管意外脱落5例(2.2%),血流量不足(血流＜180ml/min)21例(9.0%)。带管时间3～155天。结论临时性中心静脉留置导管是建立血液净化治疗血管通路的一种方便快捷方法,操作技术简便,并发症低,并能提供稳定血流量,是建立血液净化治疗临时性血液
3、通路的理想选择。【关键词】导管插入术；中心静脉；并发症；血液透析中图分类号：R318.16文献标识码：AClinicalanalysisofcentralvenouscatheterizationofbloodpurificationtherapyZHANGDihua,ZHENGZhihua,XUYuanwen,etal.DeparmentofNephrology,TheFirstAffiliatedHospitalofSunYet-senUniversity,Guangzhou510080,China【Abstract】ObjectiveToreview
4、theclinicalapplications,complicationsanditsmanage-mentofcentralvenouscatheterizationsinpatientsundergoingbloodpurificationtherapy.MethodsAretrospectivestudywasperformedin223casesofpatientsundergoingbloodpurificationtherapywithcentralvenouscathetersduringFebruary,2004toJune,2005,wh
5、ichinclude193internaljugularvenouscatheterizations(181ontherightside,12ontheleftside),21subclavianvenouscatheterizationsand9femoralvenouscatheterizations(8ontherightside,1ontheleftside).Thecomplicationsandtheirmanagementwereanalyzed.ResultsThecommonacutecomplicationsofcatheterizat
6、ionsincludedinadvertentarterialpuncturein8cases(3.6%),localhematomain10cases(4.5%)andlocalbleedingin3cases(1.3%).Thecommonlong-termcomplicationsofcatheterizationsincludedinfectionin28cases(12.6%),catheterobstructionin9cases(4.0%),catheterinadvertentwithdrawalin5cases(2.2%)andcathe
7、terinadequatebloodflow(＜180ml/min)in21cases(9.4%).Thecatheterwaskeptfor3to155days.ConclusionCentralvenouscatheterizationisaconvenientandeasywaytosetupavascularaccessforbloodpurificationtherapyandithasalowrateofcomplicationswhichcanbecontrolledeasilyandsafely.【KeyWords】Catheterizat
8、ion；Centralvenous；Complications；B
