经皮颈内静脉长期导管在老年维持性血液透析患者中的临床应用

目的：探讨经皮颈内静脉长期导管在老年维持性血液透析患者中的应用及其常见并发症的防治。方法对2009年12月至2012年12月在中南大学湘雅医院行经皮颈内静脉长期置管的15例维持性血液透析老年患者的临床资料进行回顾性分析，观察置管术后情况、导管的使用情况、常见并发症的防治、透析充分性评价等。结果（1）实施颈内静脉长期置管18例次，其中3例为重新置管，置管成功率100%。（2）导管相关并发症：2例患者术后1周内出现置管处局部渗血；1例出现导管出口感染，2例发生导管相关性血流感染；3例患者出现导管血栓形成；2例诊断导管纤维鞘形成；1例因人为损坏出现导管破裂。经过相应处理后均使问题得到解决。（3）导管使用期限：本组患者长期导管使用时间为4～41个月，除1例死亡（原因为脑出血），3例为重新置管，余患者仍继续使用。（4）透析充分性评价：15例患者平均尿素下降率为72%，平均尿素清除指数达1.54。结论对于血管条件差无法建立动静脉内瘘的老年血透患者，使用颈内静脉长期导管行血液透析可以达到充分透析；提高置管及导管护理技术、加强健康宣教，能延长导管使用年限，减少导管并发症。

Clinical application of percutaneous long-term internal jugular venous catheterization for the elderly maintenance hemodialysis patients

Objective To investigate the application of long-term percutaneous catheterization of internal jugular vein, and the prevention and management of common catheter-related complications in the elderly maintenant hemodialyisis patients. Methods Clinical data of 15 elderly maintenant hemodialyisis patients receiving percutaneous long-term catheterization of internal jugular vein in Xiangya Hospital of Central South University from December 2009 to December 2012 were collected and retrospectively analyzed. Their postoperative conditions, catheter utilization, prevention and treatment for common complications, and dialysis adequacy after cuffed catheter implantation were followed up and recorded. Results （1） A total of 18 times of implantation of internal jugular vein long-term catheter, including 3 re-implantation, were completed in the 15 patients, and the implantation success rate was 100%. （2） Catheter-related complications were local bleeding within a week postoperatively in 2 cases, catheter export infection in 1 case, bloodstream infection in 2 cases, catheter thrombosis in 3 cases, fibrin sheath on indwelling venous catheters in 2 cases, and man-made catheter rupture in 1 case. All these problems were resolved after appropriate treatment. （3） The indwelling time （months of effective catheter usage） was 4 to 41 months, except for 1 patient died due to cerebral hemorrhage, 3 patients with re-implantation. The other patients would continue to use the catheters. （4） The average urea reduction rate of 15 patients was 72%, and the average urea clearance index was 1.54. Conclusion Long-term catheterization of internal jugular vein achieves adequate dialysis in the elderly maintenance hemodialysis patients who have poor vascular conditions and are unable to establish arteriovenous fistula. Improvement of catheter implanting techniques and nursing skills, and enhancement of health education will prolong the usage of the catheters and reduce the incidence of catheter-related complications.