陈汝满 白亚飞 李洪

【摘要】血液透析中心静脉导管插管导致静脉损伤继发局部血肿是常见并发症，但围插管期无症状、插管后数月出现气管压迫、危及生命的活动性出血少见。该文报道一例45岁男性患者，因右侧颈内静脉置管后4个月出现右侧无名静脉严重活动性出血、纵隔血肿压迫气管，经过控制血压、减少容量负荷、关闭同侧内瘘后出血停止、最后血肿吸收。该例提示应重视深静脉置管穿刺损伤引发纵隔血肿的可能性，尤其在穿刺不顺利时应当立即行胸片、CT或超声检查，以减少漏诊和误诊。

【关键词】血液透析导管;插管;无名静脉;活动性出血;纵隔血肿

prolonged active hemorrhage after right innominate vein injury patient with hemodialysis： a case report Chen Ruman，Bai Yafei，Li Hong. Department of blood purification， Hainan General hospital（Hainan Affiliated Hospital of Hainan Medical University）， Haikou 570311， China

Corresponding author， Li Hong， E-mail： hpph01@163.com

【Abstract】Local hematoma is a common complication secondary to central venous catheter intubation during hemodialysis.  However， it is rare to have asymptomatic peri-intubation， tracheal compression and life-threatening active bleeding occur at several months after catheterization.This paper reports a 45-year-old male patient with severe active bleeding of right innominate vein and mediastinal hematoma compressing trachea 4 months after right internal jugular vein catheterization. After controlling blood pressure， reducing volume load， closing ipsilateral autogenous arteriovenous fistula， bleeding stopped and hematoma absorbed finally.This case suggests that extensive attention should be paid to the possibility of mediastinal hematoma caused by deep vein catheterization injury. Especially if the puncture is not successful， chest X-ray， CT scan or ultrasound examination should be performed immediately to reduce the risk of missing diagnosis and misdiagnosis.

【Key words】Hemodialysis catheter; Catheterization; Innominate vein; Active bleeding;

Mediastinal hematoma

維持性血液透析（MHD）患者，在动静脉内瘘（AVF）成熟过渡期、肾移植前过渡期或因自身血管原因、心功能差、生命有限等而使用透析导管作为MHD血管通路。静脉置管导致静脉损伤继发局部血肿是常见并发症。但围插管期无症状、插管后数月出现气管压迫、危及生命的活动性出血少见。我院收治1例右无名静脉穿刺置管损伤后超长时活动性出血罕见病例，现报道如下。

病例资料

一、主诉和现病史

患者男，45岁。因呕吐、乏力、气促2个月于2019年1月31日入院，诊断为“慢性肾炎、慢性肾脏病5期、肺部感染、慢性心功能不全”，需有隧道涤纶套导管（TCC）为过渡性通路行血液透析[1-2]。在超声引导下穿刺右侧颈内静脉，术中患者称右胸痛而停止手术，未置入导管，观察手术局部和全身均无肿胀、渗血等异常，1周后再次在超声……