Zhang Ping, Yuan Jing, Chen Jiang-hua, Wu Jian-yong, Zhang Xiao-hui, Jiang Hua
Nephrology Center, the First Affiliated Hospital, Medical College, Zhejiang University, Hangzhou 310003, China.
Zhonghua Nei Ke Za Zhi. 2004 Mar;43(3):198-200.
To observe the incidence of long-term venous indwelling catheter related complications in hemodialysis patients and to report our clinical approach to the complications.
A hundred eleven hemodialysis patients was prospectively studied from Jan. 2001 to Mar. 2003, in whom the venous indwelling catheter had been in place for more than 6 months. Catheter related complications were observed over a total period of 1090 patients months, with a mean period of 9.8 months (6 - 27 months).
The incidence of hematoma was 8.1% (9/111), and that of catheter malposition was 4.5%. There was no hemothorax, pneumothorax, air embolism or veinous laceration. Six episodes of catheter related infection were observed during the observation, with an incidence of 5.4%; two cases with bacterial infection were successfully treated; while among the 4 cases with fungal infection, one was successfully treated and catheters were removed in other 3 cases for uncontrolled infection. The incidence of catheter thrombosis was 18.9% (21/111) and the catheter had been used for a mean period of 36 days (6 - 725 days) from placement to thrombosis. Catheter patency was restored in 95.2% (20/21) by urokinase infusion. Recurrent thrombosis occurred in 18 of 20 catheters (90.0%), of which 5 worked functionally following anti-platelet therapy and 13 had recurrent thrombosis. Following anticoagulation by warfarin, 9 became functional (69.2%), but the other 4 cases turned to other vascular access. Urokinase infusion followed by anticoagulation had prolonged the mean catheter life-time for 6 months (3 - 18 months).
Cuffed dual lumen catheter as permanent access is safe and effective. Catheter thrombosis is the most common complication. Urokinase infusion followed by anticoagulation can significantly prolong the catheter life-time.
观察血液透析患者长期静脉留置导管相关并发症的发生率，并报告我们对这些并发症的临床处理方法。
对2001年1月至2003年3月期间前瞻性研究的111例血液透析患者进行观察，这些患者的静脉留置导管已放置6个月以上。在总共1090个患者月的时间内观察导管相关并发症，平均观察期为9.8个月（6 - 27个月）。
血肿发生率为8.1%（9/111），导管位置异常发生率为4.5%。未发生血胸、气胸、空气栓塞或静脉撕裂。观察期间共观察到6例导管相关感染，发生率为5.4%；2例细菌感染患者成功治愈；4例真菌感染患者中，1例成功治愈，另外3例因感染无法控制而拔除导管。导管血栓形成发生率为18.9%（21/111），从置管到血栓形成导管平均使用时间为36天（6 - 725天）。通过尿激酶灌注，95.2%（20/21）的导管恢复通畅。20例导管中有18例（90.0%）发生复发性血栓形成，其中5例经抗血小板治疗后仍能正常使用，13例再次发生血栓形成。华法林抗凝后，9例恢复功能（69.2%），但另外4例改用其他血管通路。尿激酶灌注后抗凝使导管平均使用寿命延长了6个月（3 - 18个月）。
带 cuff 的双腔导管作为永久性血管通路安全有效。导管血栓形成是最常见的并发症。尿激酶灌注后抗凝可显著延长导管使用寿命。
