Beenen L, van Leusen R, Deenik B, Bosch F H
Department of Internal Medicine, Rijnstate Hospital, Arnhem, The Netherlands.
Artif Organs. 1994 Apr;18(4):289-92. doi: 10.1111/j.1525-1594.1994.tb02197.x.
Complications related to the use of silicone subclavian catheters for hemodialysis were prospectively studied in 21 consecutive patients with acute and chronic renal failure. Between July 1991 and December 1992, 34 double-lumen silicone catheters (Medcomp; 12 French; 20 or 24 cm) were inserted in 21 patients. The mean duration of catheterization was 20 days (range, 2-58 days). Venograms were performed in 16 patients (22 subclavian veins) within 6 months following removal of the catheter. Excluded from angiography were patients whose catheters had been in place less than 1 week or who underwent fewer than 3 dialysis sessions because of minor risk of stenosis. Patients who had ipsilateral repeated catheters were also excluded. Two angiographies showed subclavian vein stenosis, both occurring in the same patient. One showed 50% stenosis with collaterals; one showed 50% stenosis without collaterals. One other complication was a pneumothorax. Catheter thrombosis was observed in 3 patients; catheter sepsis did not occur. We conclude that use of silicone catheters for subclavian cannulation is safe and effective to provide temporary vascular access for acute hemodialysis. The incidence of subclavian vein stenosis is lower compared with polytetrafluoroethylene and polyurethane catheters.
我们对21例急性和慢性肾衰竭患者前瞻性地研究了使用硅酮锁骨下导管进行血液透析的相关并发症。在1991年7月至1992年12月期间，为21例患者插入了34根双腔硅酮导管（Medcomp；12法式；20或24厘米）。导管插入的平均持续时间为20天（范围为2 - 58天）。在拔除导管后的6个月内，对16例患者（22条锁骨下静脉）进行了静脉造影。因狭窄风险较小而导管留置时间少于1周或透析次数少于3次的患者被排除在血管造影之外。同侧重复置管的患者也被排除。两次血管造影显示锁骨下静脉狭窄，均发生在同一患者身上。一次显示50%狭窄并伴有侧支循环；一次显示50%狭窄且无侧支循环。另一个并发症是气胸。观察到3例患者发生导管血栓形成；未发生导管败血症。我们得出结论，使用硅酮导管进行锁骨下插管为急性血液透析提供临时血管通路是安全有效的。与聚四氟乙烯和聚氨酯导管相比，锁骨下静脉狭窄的发生率较低。
