经左锁骨下静脉X线下留置长期双腔透析导管应用.docVIP

经左锁骨下静脉X线下留置长期双腔透析导管应用[摘要] 目的:总结11例经左锁骨下静脉在X线指引下留置长期双腔透析导管的经验。方法:按改良Seldinger 方法行左锁骨下静脉穿刺,在X 线透视条件下将导丝送达下腔静脉,再将导管顺导丝置入上腔静脉。结果:11例全获成功,其中导管留置使用10～36个月,无一例发生血胸、气胸、空气栓塞和静脉撕裂。结论:本法对于血管条件差或心功能不全无法建立内瘘的患者是一种安全、有效的选择。 [关键词] 血液透析;双腔导管;左锁骨下静脉;X-线 [中图分类号] R459.5[文献标识码] B[文章编号] 1673-7210(2010)03(b)-145-02 The application ofperennial dual-lumencatheter indwelling by left subclavian vein guided by X-ray CHEN Yangbo1, WU Wuzhong2, ZHANG Xiang2 (Ardiology Department of the People’s Hospital of Jieyang, Jieyang 522000, China; Hematology Department of the People’s Hospital of Jieyang, Jieyang 522000, China) [Abstract] Objective: To evaluate the effects of 11 cases who received perennial dual-lumencatheterbyleft subclavian vein guided by X-ray. Methods: Puncture the subclavian vein with modified Seldinger method and send the wire into the inferior vena cava guided by X-ray, then set the catheter into the superior vena cava. Results: All patients were successfully indwelled, and the catheters were kept for 10-36 months. No hemothorax, pneumothorax, air embolism or vein rupture happened. Conclusion: It’s a safe and effective method for the patients who can not use the traditional method to set up vascular access because ofheart failure or poor vascular conditions. [Key words] Hemodialysis; Dual-lumencatheter; Left subclavian vein; X-ray 建立有效的血管通路是血液透析顺利进行的先决条件。目前自体血管动静脉内瘘仍是最为理想的血管通路[1]。近年来糖尿病、高血压病、动脉硬化、肥胖及其他血管疾病的发病率明显增加,使血管通路的建立尤其是自体动静脉内瘘的建立越来越困难,另外有些患者因心功能差而不适宜或不能耐受自体动静脉内瘘手术。近年来笔者借鉴起搏器植入方法,在X线透视指引下,应用带涤纶环双腔导管经左锁骨下静脉建立血液透析通路为这部分患者建立长期血液透析通路,取得满意效果,现报道如下: 1 材料与方法 1.1 一般资料 2005～2009年我院血透中心血液透析患者11例,其中,男8例,女3例;年龄45～70岁,平均(58.5±6.0)岁。原发病:糖尿病肾病5例,慢性肾小球肾炎3例,高血压肾病2例,多囊肾1例。所有患者均为自身血管条件差,无法行动静脉内瘘手术或多次动静脉内瘘手术失败;且具有腹膜透析相对禁忌证或拒绝行腹膜透析者。 1.2 资料 带涤纶环的双腔留置导管由Quinton公司制造, 型号14.5 Fr×36 cm。此导管与普通双腔导管的主要不同为导管上有一涤纶环,导管柔软性增加,双腔导管的主开口均为直孔。 1.3 方法 患者送导管室,取平卧位,接心电监护仪,取左锁骨中点1/2锁骨下2 cm为穿刺点,常规消毒铺巾,用1%利多卡因局麻,用改良Seldinger法穿刺左锁骨下静脉并留置导引钢丝,X线透视证实导丝到达下腔静脉,根据锁骨下静脉双腔留置导管在体表投影