摘要
目的比较锁骨下静脉置管与颈内静脉置管建立临时性血液通路在置管及使用情况中的优缺点。方法采取回顾性的对照研究,438例需紧急血液透析患者中先后采用锁骨下静脉置管342例,颈内静脉置管96例。观察对比两种置管途径在首次穿刺成功率、穿刺失败率、导管留置时间及导管相关并发症等方面的差异。结果锁骨下静脉一次穿刺成功率为91%,颈内静脉93%,两者并无明显差异(P>0.05);锁骨下静脉穿刺失败率为5.9%,颈内静脉5.6%,两者无明显差异(P>0.05);锁骨下静脉置管留置时间平均58.5d,明显长于颈内静脉置管35.4d(P<0.05);锁骨下静脉置管导丝未入上腔静脉8例,显著高于颈内静脉置管0例;静脉回流不畅在锁骨下静脉置管11例,显著高于颈内静脉置管0例;锁骨下静脉置管的感染及脱管发生率均低于颈内静脉置管。结论选择颈内静脉穿刺或锁骨下静脉穿刺应根据术者穿刺技能的熟练程度、患者的要求而定,两者各有其优劣。欲在右上肢造瘘时严禁在右锁骨下静脉置管。
Objective To compare the advantage and disadvantage in indwelling catheterization and utilization through satting up temporary blood access in subclavian intravenous catheter and internal jugular vein catheter. Methods Retrospective analysis was performed on 438 patients with emergency hemodialysis, among which 342 patients were inserted subclavian intravenous catheter, 96 patients internal jugular vein. Make an observation and com- parison on the difference in first venipuncture success and failure rate,indwelling time in the hemodialysis and catheter-related complication. Results One-time venipuncture success rate was 91% in subclavian vein and was 93% in internal jugular vein, respectively. There was no significant difference（ P 〉 0.05 ） ; The venipuncture failure rate was 5.9% in subclavian vein and was 5.6% in internal jugular vein, respectively. There was no significant difference （ P 〉 0. 05） ; The mean time were 58.5 d while placed catheter via subclavian vein and 35.4 d via internal jugular vein. There was significant difference（ P 〈 0.05 ） ; The mandrin could not be achieved superior vena cava in 8 patients placed catheter via subclavian vein, which were higher than that via internal jugular vein（0 case） ; 11 patients with in- travenous catheter happened vein backflow disturbance, which were higher than that via internal jugular vein （0 ease） ; The incidence of catheter-related infection and dislocation in subclavian vein was lower than that in internal jugular vein. Conclusion Selection of puncture via subclavian or internal jugular should base on operater＇ s skill and the patient＇ s requirement, which have advantage and disadvantage respectively. Before building fistulas in right upper extremity catheterization placed in the right subclavian intravenous should be forbidden.
出处
《透析与人工器官》
2007年第4期10-12,共3页
Chinese Journal of Dialysis and Artificial Organs
关键词
锁骨下静脉
颈内静脉
双腔导管
血液净化
subclavian vein
internal jugular vein
dual-lumen catheter
blood purification
