吴康祺　范科　梁思爱

【摘要】 目的：分析和探讨带涤纶套半永久血透导管在血液透析中临床研究及应用。方法：对2011年5月-2013年5月收治的40例尿毒症患者通过建立皮下隧道及Seldinger 技术留置带涤纶套血透导管进行维持性血液透析，观察其置管使用时间及并发症等情况。结果：患者带涤纶套半永久血透导管留置时间最短者4个月，最长者超过2年且至今仍在用，平均18.5个月。与临时导管比较，血流量、尿素清除指数（KT/V）方面比较差异均无统计学意义（P>0.05）；但带涤纶套半永久血透导管出现感染、血栓形成、脱管等并发症情况更低、使用时间更长（P<0.05）。结论：带涤纶套半永久血透导管对于血管条件差、无法建立内瘘，尤其在条件有限基层医院的透析患者提供一条可行的长期血管通路，确保透析继续顺利进行具有重要意义。

【关键词】 带涤纶套半永久血透导管； 血液透析； 血管通路

Analyses of Application of Polyester Cuffed Semi-permanent Catheter in Hemodialysis/WU Kang-qi，FAN Ke，LIANG Si-ai.//Medical Innovation of China，2014，11（12）：048-050

【Abstract】 Objective： To analyze and investigate the clinical research and application of polyester cuffed semi-permanent dialysis catheter in hemodialysis. Method： 40 cases of uremic were selected form May 2011 and May 2013 which had subcutaneous tunnel established and polyester cuffed semi-permanent dialysis catheter inserted by utilizing Seldinger technique for maintenance hemodialysis. The duration of usage of the catherter and the complications were observed. Result： The shortest stay of the polyester cuffed semi-permanent dialysis catheter was 4 months and the longest time of usage was over 2 years which was still being used. The average time of usage was about 18.5 months. Compared with the temporary catherter， both of the blood flow and urea clearance index （KT/V） had no significant difference （P>0.05）. However， the polyester cuffed semi-permanent dialysis catheter had lower risks of infection， formation of thrombosis， detaching of catheter and other complications， and had a longer staying period（P<0.05）. Conclusion： Polyester cuffed semi-permanent dialysis catheter provides the possibility of establishing long term access to blood vessels for patients whose blood vessels condition is too poor to form internal fistula， especially in the local hospitals with limited resources， which plays an important role to ensure the administration of hemodialysis.

【Key words】 Polyester cuffed semi-permanent dialysis catheter； Hemodialysis； Access to blood vessels

First-authors address：Traditional Chinese Medicine Hospital of Xinxing County，Xinxing 527400，China

doi：10.3969/j.issn.1674-4985.2014.12.018

尿毒症患者尽管血液透析为其主要肾脏替代治疗方法之一，但需建立有效的血管通路，为该治疗的顺利进行提供前提条件，故称血管通路为透析患者生命线[1]。随着医学发展、透析技术进步及我国医保报销比例提高，患有尿毒症而维持透析的患者，其生存率明显提高、维持透析年限亦不断延长；但随着其透析年限的延长、年纪增大及存在糖尿病、血管硬化、静脉纤细狭窄、自身血管条件差等基础病的患者不断增多，导致具有使用时间长、并发症少的自体动静脉内瘘血管通路难以建立，或功能耗尽已成为该部分透析患者阻碍其透析治疗的主要问题，严重威胁其生命安全。对此，探讨研究建立新的可代替内瘘的血管通路尤其重要。特别是本地区受到经济、文化、技术等因素影响，大多数经济困难且自身血管差的患者无法建立内瘘，仅靠置入临时中心静脉置管作为透析短期血管通路。本文……