介入技术在血液透析患者中心静脉导管相关问题中的应用

目的总结介入技术在血液透析患者中心静脉导管相关性问题诊断及治疗中的应用。方法回顾性分析我院肾内科82例中心静脉导管相关性介入诊断、治疗患者的临床资料，包括导管置入、导管位置调整及单纯诊断性造影，总结导管纤维鞘的诊断和介入处理方法。结果本组中伴有糖尿病者33例（40.2%），既往平均置管次数（3.2±1.7）次；介入下置管共55例次，导管位置调整24例次。置管的患者中，造影提示38例患者存在中心静脉狭窄或闭塞；导管调整的患者均为颈内静脉置管，13例为左侧颈内静脉置管，导管调整的原因多为导管末端不能达到适当的位置；经造影诊断纤维鞘13例次。结论 X线介入下中心静脉导管相关操作可实时明确中心静脉情况，确保导管置入适当位置，并可对病变的中心静脉治疗后置入导管，也是导管纤维鞘的诊断和处理的有效方法之一。

Application of interventional techniques on central venous catheter related diseases in hemodialysis patients

Objective To summarize the interventional therapy on central venous catheter related diseases in hemodialysis patients. Methods We retrospectively analyzed the clinical data of 82 patients who had received interven-tional therapy for catheter related diseases. The data was consisted of catheter insertion under the X ray, adjustment to the catheter and angiography for the catheter related diagnostic procedures. We also summarized the interventional diagnosis and therapy for catheter related fibrin sheath formation. Results The incidence of diabetes mellitus was 40.2%. On an av-erage, previous cannulation times was 3.2±1.7. The number of cannulation and adjustment to the catheter under X ray was 55 and 24 respectively. In all cannulation patients, venography revealed that central venous stenosis or obstruction were found in 38 patients. In patients whose catheter position was adjusted, the sites of puncture were internal jugular vein in all. Puncture sites were left internal jugular vein in 13 patients. Cause of catheter adjustment was that the catheter tip could not reach its proper location. Venography revealed fibrin sheath formation in 13 patients. Conclusion Catheter re-lated operation using interventional techniques can ensure that the catheter is placed at a proper position. If central vein stenosis or obstruction is diagnosed, endovascular therapies including angioplasty or stent placement can be carried out and then the catheter are inserted. Venography and interventional techniques can also efficiently be used to diagnose and treat catheter related fibrin sheath formation.