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目的:观察慢性肾衰血透患者颈内静脉长期置管术后血栓形成情况,探讨其对血透的影响。方法:对108例慢性肾衰血透行颈内静脉长期置管术后半年的患者进行彩色多普勒超声检查,观察置管静脉是否有血栓形成及其形成部位、厚度、最厚血栓处流速及透析流量。结果:1既往有血栓病史或凝血酶原和血清总胆固醇指标升高的患者更易出现置管后血栓;2透析流速随血栓厚度的增加而降低;3血栓更易形成在颈内静脉与导管结合部段和颈内静脉近心段,头臂干段较少形成血栓;4最厚血栓位于颈内静脉中上段时尚可进行透析。近心段血栓厚度>4mm时透析流量将<160ml/min,透析效果多较差。结论:针对血栓病史或查血发现凝血酶原及血清总胆固醇指标高的患者需警惕置管后血栓形成,定期进行彩色多普勒超声监测。当血栓局限于颈内静脉中上段时无需特殊处理;当发现血栓位于近心段时需及时溶栓处理。
Objective: To observe the postoperative thrombosis of chronic jaundice hemodialysis patients after long-term catheterization and explore its influence on hemodialysis. Methods: 108 cases of chronic renal failure after long-term catheterization of internal jugular vein for six months after operation were examined by color Doppler ultrasonography to observe whether there was thrombosis of catheter, and its formation site, thickness, thrombotic thrombosis velocity And dialysis flow. Results: 1 Previous patients with a history of thrombosis or elevated prothrombin and serum total cholesterol were more likely to have post-catheter thrombosis 2 Dialysis flow rate decreased with thrombus thickness 3 Thrombus was more likely to form at the junction of the jugular vein and catheter Segment and the jugular vein near the heart segment, scapular trunk less thrombosis; thickest thrombosis in the upper jugular vein can dialysis. Near the heart segment thrombosis> 4mm dialysis flow rate will be <160ml / min, dialysis more poor. CONCLUSIONS: In patients with a history of thrombosis or blood tests, patients with prothrombin and high serum total cholesterol levels should be alert to thrombosis after catheterization and perform regular color Doppler ultrasound monitoring. When thrombosis confined to the upper jugular vein without special treatment; when the thrombus is found in the proximal segment of the thrombolytic treatment should be promptly.