第30卷第12期第三军医大学学报V01．30，No．1212062008年6月ACTAACADEMIAEMEDICINAEMILITARISTERTIAEJun．2008辇论著莲不同途径中心静脉置管对血液透析并发症的影响文章编号：1000-s404(2008)12—1206—03昊亿，赵洪雯，王殿珍，王军霞，彭侃夫，吴雄飞(第三军医大学西南医院肾科，重庆400038)摘要：目的总结中心静脉置管(CVC)在血液透析患者中的应用，探讨导管合理留置途径、时间及并发症防治。方法回顾性分析7年间我科对1966例急、慢性肾功能衰竭患者穿刺股静脉、锁骨下静脉和颈内静脉3个部位CVC共2000例次，其中股静脉450例次，锁骨下静脉86例次，颈内静脉l464例次。结果股静脉留置5—75(20．5±13．1)d，血栓形成19．11％，感染18．22％，误穿入动脉5．77％，穿刺总渗血4％，导管脱出2．22％，血肿形成1．33％；锁骨下静脉留置10～84(41．8±20．1)d，感染12．79％，血栓形成9．3％，误穿入动脉9．3％，穿刺点渗血5．81％，血肿形成3．48％，血、气胸2．33％，导管脱出1．16％；颈内静脉留置12—155(53．8±28．5)d，误穿人动脉13．4％，感染8．06％，血栓形成6．08％，穿刺点渗血1．91％，血肿形成0．68％，导管脱出0．27％，心律失常0．10％，损伤喉返神经0．05％。结论血液透析应用CVC具有快捷、方便、安全的优点，导管留置时间在颈内静脉比股静脉和锁骨下静脉明显延长。并发症的发生率在股静脉最高，其次为锁骨下静脉和颈内静脉。颈内静脉置管可作为临床上首选方法。关键词：中心静脉置管；血液透析中图法分类号：R459．5；R472．9文献标识码：AComplicationsofcentralvenouscatheterinsertionthrough3approachesinhemodialysisWUYi，ZHAOHong-wen，WANGDian-zhen，WANGJun-xia，PENGKan-fu，WUXiong—fei(DepartmentofUrology，SouthwestHospital．ThirdMilitaryMedicalUniversity，Chongqing400038，China)Abstract：ObjectiveTosummarizetheclinicalapplicationofcentralvenouscathetersinhemodialysisandexplorethebettercentralvenouscatheterinsertionsite．cat}leterizationtimeandthepreventionandcureofcatheter．relatedcomplications．MethodsWeretrospectivelyanalyzed2000timesofcentralvenouscatheteriza-tionin1966patientsofacuteorchronicrenalfailuretreatedinourdepartmentfromJanuary2000toJune2007．Thecatheterinsertionsitewasfemoralveinin450cases，subclavianveinin86cases，andinternaliugularveinin1464cases．ResultsTheeatheterizationtimeinfemoralveinranged5—75d(mean20．5-i-l3．1)，thatinsubclavianvein10—84d(mean41．8±20．1)，andthatininternaljugularvein12—155d(mean53．8±28．5)．Infectionsoccurredin21lpatientsandbloodcloggingincatheterin183，bothmainlyinthoseundergo-inginternaljugularveincatheterizationorfemoralveincatheterization．Accidentalwithdrawalcatheterhappenedin15patients，mainlyinthoseundergoingfemoralveincatheterization．Localhematomaoccurredin19，errhys-isin81，andarrhythmiain2，allmainlyinthoseundergoinginternaljugularveincatheterization．ConclusionTheadvantagesofcentralvenouscatheterizationinhemodialysisareshortcut．convenienceandsafety．TheeatlleterizationtimeininternaliugularveiniSlongerthanthatinfemoralveinandsubclavianvein．Thecathe．ter—relatedcomplicationsoccurredmoreofteninfemoralveinthaninsubclavianveinandinternaljugularvein．ThefirstchoiceofcatheterinsertionsiteiSinternaliugularveininclinicaloperation．words：centralvenouscatheter；hemodialysis血管通路是行血液透析(hemodialysis，HD)治疗必不可少的前提条件。稳定而可靠的血管通路是治疗正常进行的保证，中心静脉置管(centralvenouscatheter，作者简介：吴亿．女，重庆市人，主管护师，主要从事肾脏病护理、血液净化护理方面的研究．电话：(023)胡765338通信作者：吴雄飞．电话：(023)醴754l韶．E—mail：Wuxfei@126．o”收稿日期：2007—09-20；修回日期：2008-03—04C...
