袁茜　李绍华　孙岩

[摘 要] 目的：探讨B超引导下颈内静脉置管在尿毒症血液透析患者中应用。方法：选择本院2014年5月—2015年12月收治的200例需行颈内静脉置管血液透析的尿毒症患者，随机分为A组（超声引导下，98例）和B组（盲探下，102例）行颈内静脉置管，比较穿刺置管成功率、穿刺时间、患者满意度、并发症以及导管首次透析血流量、尿素氮下降率（URR）、整体尿素氮清除率（Kt/v）。结果：两组患者一般情况相比差异无统计学意义，具有可比性；A组患者穿刺置管时间明显短于B组，穿刺置管一次成功率、总成功率以及患者满意度明显高于B组，差异有统计学意义，P<0.05；A组患者的总并发症发生率明显低于B组，其中颈动脉损伤、神经损伤、局部血肿的发生率相比差异有统计学意义，P<0.05，血气胸的发生率相比差异无统计学意义；A组患者首次血液透析血流量、URR和Kt/v均高于B组，但两组间比较差异无统计学意义。结论：超声引导下颈内静脉置管不仅可以缩短穿刺时间、提高穿刺成功率和患者的满意度并且能提高尿毒症血液透析患者的透析效果、降低并发症发生率。

[关键词] 超声引导；颈内静脉置管；尿毒症；血液透析

中图分类号：R459.5 文献标识码：B 文章编号：2095-5200（2016）05-100-04

[Abstract] Objective： To investigate the application of B-ultrasound guided internal jugular venous catheterization in hemodialysis patients with uremia. Methods： A total of 200 hemodialysis patients with uremia， who underwent internal jugular vein catheterization in our hospital from May 2014 to December 2015， were randomly divided into group A （under ultrasound guidance， 98 cases） and group B （blind detection， 102 cases） underwent internal jugular vein catheterization， compared the success rate of puncture， puncture time， the satisfaction of patients， complications and blood-flow amount of the first hemodialysis， urea reduction rate （URR）， urea nitrogen （Kt/v） removal rate. Results： Two groups of patients were compared generally， there was no significant difference； catheterization time of patients in group A was significantly shorter than that of group B， first puncture success rate， total success rate and patient satisfaction of group A were all significantly higher than those of group B， the difference were statistically significant between the two groups （P<0.05）； total complications occurring rate of group A was significantly lower than that of group B， and their incidence rates of carotid artery injury， nerve injury， local hematoma had significant difference （P<0.05）， there was no significant difference in the incidence of pneumothorax； blood-flow amount of the first hemodialysis， URR and Kt/v in patients of group A were higher than those of group B， but there were no significant differences between two groups. Conclusions： Ultrasound guided internal jugular vein catheterization can not only shorten the puncture time， improve the success rate of puncture and patients satisfaction， but also can improve the dialysis effect and reduce the incidence of complications in hemodialysis patients with uremia.

[Key words] ultrasound guided internal jugular vein catheterization uremia hemodialysis

透析是尿毒症患者肾脏替代治疗的重要手段[1]，血液透析是不能进行腹膜透析尿毒症患者维持生命的主要方法[2-3]。维持和建立具有良好功能的血管通路是保证患者顺利充分透析的关键[4]。自体动静脉内瘘是尿毒症患者长期血液透析的首选血管通路，而对于患有糖尿病、血管炎、动脉粥样硬化等血管疾病以及伴有心功能不全患者，常无法顺利建立自体动静脉内瘘，需深静脉留置血液透析导管[5-6]。颈内静脉穿刺置管受其解剖结构特点的影响，盲探操作不仅可能会导致穿刺失败而且操作不当及反复操作会增加并发症的发生率，严重者甚至威胁患者的生命安全[7-8]。超声的应用使深静脉穿刺得以顺利完成，本研究将探讨B超引导下颈内静脉置管在尿毒症血液透析患者中应用，为尿毒症血液透析患者颈内静脉置管操作提供参考。……