半永久颈内静脉置管通路再循环对血液透析充分性的影响

摘要

目的 观察半永久颈内静脉留置导管透析时血流量、通路再循环及对透析充分性的影响.方法 选择行长期维持性血液透析患者60例,随机分为半永久颈内静脉置管组(置管组)和动静脉内瘘组(内瘘组),每组30例.透析时设定同样的血泵速度(250 ml/min)、使用相同型号规格的透析器、透析时间相同,观察6、12个月时有效血流量(Qb)、尿素清除指数(Kt/V)、通路再循环率(Ret%),并计算尿素下降率(URR).同时记录导管相关感染、血栓形成等并发症.结果 2组患者有效血流量均可达到220～235 ml/min,使用6、12个月时的Qb、Ret%、Kt/V、URR 2组比较差异均无统计学意义(P＞0.05),Kt/V均达到或超过1.2,URR高于65%,达到小分子清除充分性的要求.结论 半永久颈内静脉留置导管可作为血管通路,能较长时间使用且能提供足够的有效血流量,从而满足单次透析达到透析充分性的血流要求.%Objective To observe the blood flow,nccess recirlulation and effect on hemodialysis adequacy in patients using jugular veins indwelling catheter. Methods 30 patients who needed prolonged temporary vascular access to placement jugular veins indwelling catheter. The control group comprised 30 patients dialysing simultaneously in the same units with AV access. The dialyses were performed at the same blood rate of 250 ml/min during treatment. The blood flow ( Qb ), the index of urea clearance ( Kt/V), the recirculation rate ( Ret% ) and the urea reduction rate ( URR ) were measured at the 6th and the 12th month. The catheter related infections and thrombosis were recorded. Results Both the mean blood rate of the two groups were around 220 - 235 ml/min. There was no significant difference of Qb, Ret% , Kt/V and URR between the two groups tested at the 6th and the 12th month( P >0. 05 ). The Kt/V of all patients were achieved at or more than 1.2, and the URR were > 65% ( acceptable haemodialysis dose ). Conclusion Prolonged use of the internal jugular vein dwelling catheter was capable of providing both better sustained higher blood flow and adequate access for haemodialysis.