数字减影血管造影下血液透析长期导管改良的临床应用
|
摘要
目的:探讨在数字减影血管造影技术(DSA)可视下血液透析长期导管留置建立方法及效果。方法:选取68例因自身动静脉条件差无法行动静脉内瘘术,或原动静脉内瘘不能维持血液透析而施行长期导管置管术的患者,所有患者均系终末期肾衰竭需长期维持血液透析治疗。按手术方式的不同,将68例患者分为传统手术组(10例)和改良手术组(58例),传统手术组采用传统的颈内静脉长期导管置管术,应用Seldinger技术结合撕脱鞘进行置管;改良手术组采用改进的颈内静脉长期置管术,应用导引钢丝引导进行导管置入。观察两种置管术的难易程度及术中及术后出血等情况。结果:传统手术组的患者中,4例因隧道皮下组织收缩不能一次性将导管涤纶套放置在皮下所需位置,7例术中发生出血(>10 ml),6例术后48 h内发生明显穿刺点或隧道出口渗血。改良手术组全部一次性将导管涤纶套放置在所需的位置,仅2例出现明显穿刺点或隧道出口出血。结论:在DSA下行带涤纶套长期导管置管具有定位准确、操作安全及调管方便等优点,两种置管术中改良手术组采用的改进颈内静脉长期置管术出血量小,安全效果更好。
Objective: To investigate the modified method and the effect of establishing longterm catheter indwelling under DSA in hemodialysis. Methods: 68 patients were selected to treated with long-term catheter of polyester set in DSA, which were in the end stage of renal failure with long-term hemodialysis therapy. In these patients, some of them couldn't receive intra-arteriovenous fistula surgery because their arteriovenous were poor quality and others had treated with long-term catheter dwelling because their intra-arteriovenous fistula couldn't keep hemodialysis. 68 patients were divided into traditional surgery group and improved surgical group according to different operation methods. 10 cases of traditional surgery group were done with traditional long-term catheterization of internal jugular vein, and 58 cases of improved surgical group with improved long-term catheterization of internal jugular vein catheter. The traditional long-term catheterization was combined Seldinger technology with avulsion of the catheter sheath. The improved method was done by the guide wire. To observe series of operation result, such as the difficulty level, bleeding during and after operation. Results: In 10 traditional catheterization cases, 4 cases couldn't be placed catheter of polyester set under the skin at once because of the contraction of the subcutaneous tissue. 7 cases occurred bleeding above 10 ml during operation. In 6 cases, there was an obvious puncture point or tunnel outlet bleeding in 48 hours. Improved intubation patients all disposable catheter placement in the desired position at once. In only 2 cases, there was a significant puncture point or bleeding in the tunnel. Conclusion: With the help of DSA guidance, long-term catheterization can be performed accurately, safely and easily. By the improved method, the amount of bleeding is smaller, and the safety effect is better.
Objective: To investigate the modified method and the effect of establishing longterm catheter indwelling under DSA in hemodialysis. Methods: 68 patients were selected to treated with long-term catheter of polyester set in DSA, which were in the end stage of renal failure with long-term hemodialysis therapy. In these patients, some of them couldn't receive intra-arteriovenous fistula surgery because their arteriovenous were poor quality and others had treated with long-term catheter dwelling because their intra-arteriovenous fistula couldn't keep hemodialysis. 68 patients were divided into traditional surgery group and improved surgical group according to different operation methods. 10 cases of traditional surgery group were done with traditional long-term catheterization of internal jugular vein, and 58 cases of improved surgical group with improved long-term catheterization of internal jugular vein catheter. The traditional long-term catheterization was combined Seldinger technology with avulsion of the catheter sheath. The improved method was done by the guide wire. To observe series of operation result, such as the difficulty level, bleeding during and after operation. Results: In 10 traditional catheterization cases, 4 cases couldn't be placed catheter of polyester set under the skin at once because of the contraction of the subcutaneous tissue. 7 cases occurred bleeding above 10 ml during operation. In 6 cases, there was an obvious puncture point or tunnel outlet bleeding in 48 hours. Improved intubation patients all disposable catheter placement in the desired position at once. In only 2 cases, there was a significant puncture point or bleeding in the tunnel. Conclusion: With the help of DSA guidance, long-term catheterization can be performed accurately, safely and easily. By the improved method, the amount of bleeding is smaller, and the safety effect is better.
引文
[1]Vascular Access Work Group.Clinical practice guidelines for vascular access[J].Am J Kidney Dis,2006,48(Suppl 1):S248-S273.
[2]Daviddson D,Louridas G,Guzman R,et al.Steal Syndromecomplicating upper extremity hemoaccess Procedures:incidence and risk factor[J].can J Surg,2003,46(6):408-412.
[3]Zamani P,Kaufman J,Kinlay S.Lschemic steal syndrome following arm arteriovenous fistula for hemodialysis[J].Vasc Med,2009,14(4):71-376
[4]朱蓓,裴小华,王翠玉,等.老年血液透析患者锁骨下静脉狭窄的诊治分析[J].中国血液净化,2013,12(4):226-227.
[5]谢超,肖观清,孔耀中.经右颈内静脉置管进入左头臂静脉一例报道[J].中华肾脏病杂志,2014,30(2):159.
[6]白旭明,石永兵,唐梅,等.DSA下长期性血液透析导管的留置[J].介入放射学杂志,2010,19(2):134-137.
[7]叶朝阳.带涤纶套中央静脉留置管的选择应用于并发症防止[J].中国血液净化,2007,6(7):365-368.
[8]卢方平.动静脉血管通路建立策略[J].国际移植与血液净化杂志,2016,14(1)43-44.
[9]Dupont D,Moriniere P,Pourchez T,et al.Longterm development of Permacath Quinton catheters used as a vascular access route for extra-renal detoxification[J].Nephrologie,1994,15:105-110.
[10]李明,敖华,陈文祥,等.数字减影血管造影技术引导在长期血液透析导管置管的应用价值[J].内科急危重症杂志,2015,21(5):341-343.
[11]Nakazawa N.Infectious and thrombotic complications of central venous catheters[J].Semin Oncol Nurs,2010,26(2):121-131.
[12]何小平.永久性颈内静脉置管在血液透析中的运用[J].中国当代医药,2011,18(25):36-37.
[13]周树录,张虹,化宝军,等.颈内静脉长期导管置管手术的改进[J/CD].中华临床医师杂志:电子版,2012,6(15):4500-4501.
[14]朱富祥,徐宏,周亦菁.不使用撕脱型扩张导管放置长期血液透析导管8例体会[J].中国中西医结合肾病杂志,2011,12(1):69-69.
[15]王艳辉,王建爽.超声引导在临时性血液透析患者中心静脉置管术中的应用[J].中国医学装备,2016,13(3):78-80,81.
[16]周家蕃,梁佩芳,严静宜,等.CT下颈内静脉与颈总动脉间解剖关系的研究[J].中国血液净化,2013,12(3):145-148.
[17]刘友军,刘桂杰,于文文,等.DSA在缺血性脑血管病诊治中的应用[J].中国医学装备,2010,7(10)37-39.
[18]蒋欣欣,沈维,许秀君,等.颈内静脉带隧道带涤纶套导管异位的介入治疗[J].中华肾脏病杂志,2016,32(1):63-63.
[19]詹申,杨涛,张丽红,等.球囊破坏纤维鞘纠正血液透析导管功能不良效果观察[J].中国血液净化,2014,13(5):405-407.
[2]Daviddson D,Louridas G,Guzman R,et al.Steal Syndromecomplicating upper extremity hemoaccess Procedures:incidence and risk factor[J].can J Surg,2003,46(6):408-412.
[3]Zamani P,Kaufman J,Kinlay S.Lschemic steal syndrome following arm arteriovenous fistula for hemodialysis[J].Vasc Med,2009,14(4):71-376
[4]朱蓓,裴小华,王翠玉,等.老年血液透析患者锁骨下静脉狭窄的诊治分析[J].中国血液净化,2013,12(4):226-227.
[5]谢超,肖观清,孔耀中.经右颈内静脉置管进入左头臂静脉一例报道[J].中华肾脏病杂志,2014,30(2):159.
[6]白旭明,石永兵,唐梅,等.DSA下长期性血液透析导管的留置[J].介入放射学杂志,2010,19(2):134-137.
[7]叶朝阳.带涤纶套中央静脉留置管的选择应用于并发症防止[J].中国血液净化,2007,6(7):365-368.
[8]卢方平.动静脉血管通路建立策略[J].国际移植与血液净化杂志,2016,14(1)43-44.
[9]Dupont D,Moriniere P,Pourchez T,et al.Longterm development of Permacath Quinton catheters used as a vascular access route for extra-renal detoxification[J].Nephrologie,1994,15:105-110.
[10]李明,敖华,陈文祥,等.数字减影血管造影技术引导在长期血液透析导管置管的应用价值[J].内科急危重症杂志,2015,21(5):341-343.
[11]Nakazawa N.Infectious and thrombotic complications of central venous catheters[J].Semin Oncol Nurs,2010,26(2):121-131.
[12]何小平.永久性颈内静脉置管在血液透析中的运用[J].中国当代医药,2011,18(25):36-37.
[13]周树录,张虹,化宝军,等.颈内静脉长期导管置管手术的改进[J/CD].中华临床医师杂志:电子版,2012,6(15):4500-4501.
[14]朱富祥,徐宏,周亦菁.不使用撕脱型扩张导管放置长期血液透析导管8例体会[J].中国中西医结合肾病杂志,2011,12(1):69-69.
[15]王艳辉,王建爽.超声引导在临时性血液透析患者中心静脉置管术中的应用[J].中国医学装备,2016,13(3):78-80,81.
[16]周家蕃,梁佩芳,严静宜,等.CT下颈内静脉与颈总动脉间解剖关系的研究[J].中国血液净化,2013,12(3):145-148.
[17]刘友军,刘桂杰,于文文,等.DSA在缺血性脑血管病诊治中的应用[J].中国医学装备,2010,7(10)37-39.
[18]蒋欣欣,沈维,许秀君,等.颈内静脉带隧道带涤纶套导管异位的介入治疗[J].中华肾脏病杂志,2016,32(1):63-63.
[19]詹申,杨涛,张丽红,等.球囊破坏纤维鞘纠正血液透析导管功能不良效果观察[J].中国血液净化,2014,13(5):405-407.