CAJ | 학술논문

目的:探讨涤纶套深静脉留置导管血液透析的使用和退出原因.方法:分析置管方法与血流通畅情况,随访留置导管的使用和并发症,记录导管使用终点.结果:实施深静脉留置长期带涤纶套导管术216例,右颈内静脉置管209例,成功率96.8%,左侧颈内置管5例,2例经股静脉;导管使用期限:平均(15±13)个月,使用留置导管时间分别为:＞36月56例,＞24月75例,＞12月45例,＞6月25例,<6个月15例(大部分在继续使用),28例失访.观察导管使用终点105例,约占49.5%,导管退出时使用时间2～28月.平均(10±5)个月;退出原因:死亡52例,其余为感染拔管、血流不畅和肾移植.在导管使用终点,90.5%(95/105)的导管功能良好;导管透析充分性:151例患者的透析后尿素下降率平均70%,平均Kt/V达到1.45;与内瘘透析患者Kt/V=(1.51±0.30)比较,二者差异无统计学意义(P<0.05).左侧颈内静脉置管血流不畅发生率高;感染25例,治疗有效23例,无效拔管2例.结论:长期导管可以达到充分透析;长期导管使用人群主要是老年人、等待肾移植和多次内瘘失败者,良好的导管留置技术提高导管的有效使用,尽量采用右侧颈内静脉置管,良好的护理显著降低导管感染率.
목적:탐토조륜투심정맥류치도관혈액투석적사용화퇴출원인.방법:분석치관방법여혈류통창정황,수방류치도관적사용화병발증,기록도관사용종점.결과:실시심정맥류치장기대조륜투도관술216례,우경내정맥치관209례,성공솔96.8%,좌측경내치관5례,2례경고정맥;도관사용기한:평균(15±13)개월,사용류치도관시간분별위:＞36월56례,＞24월75례,＞12월45례,＞6월25례,<6개월15례(대부분재계속사용),28례실방.관찰도관사용종점105례,약점49.5%,도관퇴출시사용시간2～28월.평균(10±5)개월;퇴출원인:사망52례,기여위감염발관、혈류불창화신이식.재도관사용종점,90.5%(95/105)적도관공능량호;도관투석충분성:151례환자적투석후뇨소하강솔평균70%,평균Kt/V체도1.45;여내루투석환자Kt/V=(1.51±0.30)비교,이자차이무통계학의의(P<0.05).좌측경내정맥치관혈류불창발생솔고;감염25례,치료유효23례,무효발관2례.결론:장기도관가이체도충분투석;장기도관사용인군주요시노년인、등대신이식화다차내루실패자,량호적도관류치기술제고도관적유효사용,진량채용우측경내정맥치관,량호적호리현저강저도관감염솔.
Objective:To analyze the causes of using tunnel cuffed catheters and its using end - point. Methods:The Paten-cy of catheters and their complications were observed, The end - points of catheters were recorded. Results:The dual lumen cuffed catheters were implanted in 216 cases of chronic renal failure(CRY') patients. Two hundred and nine catheters were implanted in the right internal jugular vein. The using period were as follows: there were 56 cases longer than 36 months,75 cases longer than or equal to24 months,45 cases longer than or equal to 12 months,25 cases longer than or equal to 6 months and 15 cases shorter than 6 months (15±13 months in average). One hundred and five cases were followed up until the end- point of the investigation. At the end point,the catheters had been used for 2 months to 28 months(10 months in average),and quitting causes were death,infec-tion,puU- out,dysfunction and renal transplantation; Dialysis adequacy: the average Kt/V was 1.45, URR was 0.7 in 151 cuffed catheter cases;The function of catheters in right internal jugular vein was inferior to that in left internal jugular vein. The dysfunc-tion of catheters in the left internal jugular happened more often than that in right vein; Infection occurred in the 25 cases, and 23 were cured,but 2 failed to he controlled. Conclusion:The cuffed catheters are mainly used for the elderly patients and those who failed to create AVF. The patients could get adequate dialysis by cuffed catheters hemodialysis. Good catheter planting technique is important for effective using of catheter and reducing infection. The catheters should be implanted in the right Internal jugular for the good function.