CAJ | 학술논문

目的：探讨经皮颈内静脉长期导管在老年维持性血液透析患者中的应用及其常见并发症的防治。方法对2009年12月至2012年12月在中南大学湘雅医院行经皮颈内静脉长期置管的15例维持性血液透析老年患者的临床资料进行回顾性分析，观察置管术后情况、导管的使用情况、常见并发症的防治、透析充分性评价等。结果（1）实施颈内静脉长期置管18例次，其中3例为重新置管，置管成功率100%。（2）导管相关并发症：2例患者术后1周内出现置管处局部渗血；1例出现导管出口感染，2例发生导管相关性血流感染；3例患者出现导管血栓形成；2例诊断导管纤维鞘形成；1例因人为损坏出现导管破裂。经过相应处理后均使问题得到解决。（3）导管使用期限：本组患者长期导管使用时间为4～41个月，除1例死亡（原因为脑出血），3例为重新置管，余患者仍继续使用。（4）透析充分性评价：15例患者平均尿素下降率为72%，平均尿素清除指数达1.54。结论对于血管条件差无法建立动静脉内瘘的老年血透患者，使用颈内静脉长期导管行血液透析可以达到充分透析；提高置管及导管护理技术、加强健康宣教，能延长导管使用年限，减少导管并发症。
목적：탐토경피경내정맥장기도관재노년유지성혈액투석환자중적응용급기상견병발증적방치。방법대2009년12월지2012년12월재중남대학상아의원행경피경내정맥장기치관적15례유지성혈액투석노년환자적림상자료진행회고성분석，관찰치관술후정황、도관적사용정황、상견병발증적방치、투석충분성평개등。결과（1）실시경내정맥장기치관18례차，기중3례위중신치관，치관성공솔100%。（2）도관상관병발증：2례환자술후1주내출현치관처국부삼혈；1례출현도관출구감염，2례발생도관상관성혈류감염；3례환자출현도관혈전형성；2례진단도관섬유초형성；1례인인위손배출현도관파렬。경과상응처리후균사문제득도해결。（3）도관사용기한：본조환자장기도관사용시간위4～41개월，제1례사망（원인위뇌출혈），3례위중신치관，여환자잉계속사용。（4）투석충분성평개：15례환자평균뇨소하강솔위72%，평균뇨소청제지수체1.54。결론대우혈관조건차무법건립동정맥내루적노년혈투환자，사용경내정맥장기도관행혈액투석가이체도충분투석；제고치관급도관호리기술、가강건강선교，능연장도관사용년한，감소도관병발증。
Objective To investigate the application of long-term percutaneous catheterization of internal jugular vein, and the prevention and management of common catheter-related complications in the elderly maintenant hemodialyisis patients. Methods Clinical data of 15 elderly maintenant hemodialyisis patients receiving percutaneous long-term catheterization of internal jugular vein in Xiangya Hospital of Central South University from December 2009 to December 2012 were collected and retrospectively analyzed. Their postoperative conditions, catheter utilization, prevention and treatment for common complications, and dialysis adequacy after cuffed catheter implantation were followed up and recorded. Results (1) A total of 18 times of implantation of internal jugular vein long-term catheter, including 3 re-implantation, were completed in the 15 patients, and the implantation success rate was 100%. (2) Catheter-related complications were local bleeding within a week postoperatively in 2 cases, catheter export infection in 1 case, bloodstream infection in 2 cases, catheter thrombosis in 3 cases, fibrin sheath on indwelling venous catheters in 2 cases, and man-made catheter rupture in 1 case. All these problems were resolved after appropriate treatment. (3) The indwelling time (months of effective catheter usage) was 4 to 41 months, except for 1 patient died due to cerebral hemorrhage, 3 patients with re-implantation. The other patients would continue to use the catheters. (4) The average urea reduction rate of 15 patients was 72%, and the average urea clearance index was 1.54. Conclusion Long-term catheterization of internal jugular vein achieves adequate dialysis in the elderly maintenance hemodialysis patients who have poor vascular conditions and are unable to establish arteriovenous fistula. Improvement of catheter implanting techniques and nursing skills, and enhancement of health education will prolong the usage of the catheters and reduce the incidence of catheter-related complications.