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目的探讨尿毒症心衰患者非常规体位时超声引导下深静脉置管的安全性及有效性。方法回顾性分析2012年12月至2015年12月西南医院肾科148例尿毒症心衰患者病例(男性77例,女性71例,年龄25~67岁,平均45.2岁),比较、分析其在超声引导下深静脉置管成功率,穿刺时体位,穿刺时间,穿刺部位及相关并发症。结果 148例患者半卧位置管89.2%,端坐位置管10.8%,超声引导下深静脉置管成功率为100%,一次穿刺成功率为90.5%,穿刺时间6~20 min,穿刺并发症1.4%。颈内静脉置管84.5%,股静脉置管15.5%。颈内静脉置管感染、血栓及血流量不足发生率低于股静脉置管者(P<0.05)。结论超声引导下深静脉置管可突破尿毒症心衰患者在置管时对穿刺体位的局限,提高其在非常规体位时颈内静脉置管成功率,减少并发症。
Objective To investigate the safety and efficacy of ultrasound-guided catheterization of deep venous catheter in unconventional position of uremic patients with heart failure. Methods A retrospective analysis of 148 patients with uremia and heart failure (77 males and 71 females, aged 25-67 years, mean 45.2 years) from January 2012 to December 2015 in the Department of Nephrology, Southwest Hospital of China was performed. Ultrasound-guided success rate of deep vein catheterization, puncture position, puncture time, puncture site and related complications. Results In 148 patients, 89.2% of the tubes were placed in half-position and 10.8% in the sitting position. The success rate of ultrasound-guided deep vein catheterization was 100%. The success rate of primary puncture was 90.5%, puncture time was 6-20 min, and puncture complication 1.4 %. Internal jugular vein catheter 84.5%, femoral vein catheter 15.5%. The incidence of internal jugular vein catheter infection, thrombus and blood flow insufficiency was lower than that of femoral vein catheter (P <0.05). Conclusion Ultrasound-guided catheterization of deep veins can break the limitation of puncture position during catheterization in uremic patients with heart failure and improve the success rate of catheterization in jugular venous catheter in unconventional position and reduce the complications.