何琼?汤学宇

【摘要】中心静脉置管技术在临床上应用广泛，其置管相关并发症也不容忽视。该例维持性血液透析患者在彩色多普勒超声引导下行左侧颈内静脉留置长期透析导管术时出现抵抗感，置管完成后回抽导管动静脉端回血不畅，术后行胸部CT及数字减影血管造影检查发现导管末端进入中纵隔内，未伤及纵隔内血管，予以20 d后导管末端血肿机化后拔除留置导管。该例提示左颈内静脉置管误穿中纵隔可致一些严重甚至致命的并发症，熟悉相关解剖结构、提高置管技术、及时行相关医技检查及治疗是防治并发症的关键。

【关键词】中心静脉置管;并发症;纵隔;检查;治疗

Treatment and analysis of tunneled cuffed left internal jugular vein catheter tip misplaced in mediastinum： one case report He Qiong， Tang Xueyu. Department of Nephrology， Xiangnan Hospital Affiliated to Hunan Normal University & 922 Hospital of PLA ， Hengyang 421002， China

Corresponding author， Tang Xueyu， E-mail： xytang169@ 163. com

【Abstract】The central venous catheterization（CVC） has been widely applied in clinical practice. However， the complications induced by CVC can not be neglected. In this article， one patient presented with resistance during the period of indwelling the tunneled cuffed left internal jugular vein catheter guided by ultrasonography and failed to achieve smooth drainage after CVC. Postoperative CT scan of the chest and DSA showed the catheter tip was misplaced in the middle mediastinum without vascular trauma. The catheter was removed at 20 d after the hematoma was organized around the tip. Malpositioning of tunneled cuffed left internal jugular vein catheter tip in the mediastinum can cause severe and even fatal complications. Intimate knowledge of anatomical structures， improvement of catheter indwelling technique， timely relevant examinations and treatment are the key to prevent and treat complications.

【Key words】Central venous catheterization;Complication;Mediastinum;Examinations;Treatment

中心静脉置管术是指在导丝的引导下经颈内静脉、颈外静脉、锁骨下静脉、股静脉将导管置入腔静脉，在临床中作为血液透析患者的血管通路应用非常普遍。中心静脉置管术可导致一些少见且严重的并发症如血管损伤、血肿形成、空气栓塞、心房穿孔、气胸、心律失常、心脏骤停、喉返神经损伤、气管撕裂等，严重者可危及患者生命[1]。在临床工作中提高对中心静脉置管严重并发症的认识十分必要，現将我院1例行左颈内静脉带隧道和涤纶套的透析导管置管术误穿纵隔后成功拔除导管的病例分析报告如下。

病例资料

一、主诉和现病史

患者女，74岁。因维持性血液透析治疗3年余，动静脉导管脱出10 d余于2018年9月3日入院。患者3年前因发现肾功能不全、纳差、四肢乏力1周在我科住院治疗，经完善相关检验、检查后，诊断为慢性肾功能不全尿毒症期、肾性贫血，予以行深静脉置管并血液透析、改善贫血等对症支持治疗，症状好转后出院。……