- 期刊
- OpenAccess
血液透析雙腔導管置放術與鎖骨下靜脈狹窄：電腦數位遞減術血管攝影的臨床應用
Three-year Experience of Subclavian Vein Double-Lumen Catheters as Temporary Access for Hemodialysis: The Clinical Application of DSA in Subclavian Vein Stenosis
摘要
鎖骨下靜脈血液透析雙腔導管(Subclavian vein double-lumen catheters for hemodialysis, SCVC)之留置，近年來已成為普遍接受的暫時性血管通路方式。本院自1988年7月至1990年6月，共有65位病人施行74次此置放術。包括男性32人，女性33人；年齡17歲至78歲（平均50±16歲）。留置雙腔導管之病人數為，急性腎衰竭10人，共11次(15%)；慢性腎衰竭55人，共63次(85%)。雙腔導管的留置時間，由1天至44天（平均17±10天）；置放的位置：右側64次(87%)。左側10次(13%)。留置後，都接受緊急的胸部X光檢查。急性併發症，包括：縱膈腔血腫1次(1.4%)，穿刺處持續出血2次(2.7%)，都無氣胸或血胸之發生。慢性併發症，包括：管腔阻塞或血流不足有13次(17.6%)，穿刺處局部感染6次(8.1%)；其中合併菌血症1次(1.4%)和合併黴菌血症2次(2.7%)。追踪至1991年6月，共有10位病人於拔除雙腔導管後的l至22個月（平均7±6個月）,接受了上肢靜脈的電腦數位遞減術血管攝影檢查（即DSA），其中3病例發生鎖骨下靜脈嚴重狹窄或完全阻塞(severe stenosis or occlusion)，占30%。所以我們認為：鎖骨下靜脈血液透析雙腔導管置放術，為一相當安全、有效的暫時性血管通路；但因高比例的病人發生鎖骨下靜脈嚴重狹窄或阻塞，會造成往後同側上肢建立永久性血管通路的困難，應改行內頸靜脈穿刺術；而曾接受SCVC的患者，若欲建立上肢血管通路，均應接受DSA檢查，以排除鎖骨下靜脈狹窄或阻塞發生之可能性。
並列摘要
From July 1988 to June 1990, we performed 74 consecutive subclavian vein double-lumen catheters (SCVC) for hemodialysis in 65 patients (32 males & 33 females) from 17 to 78 years of age, with a mean of 50 years. The indication for catheter insertion was acute renal failure in 10 cases (15%) and chronic renal failure in 55 cases (85%) without vascular access. The mean duration of catheter insertion was 17±10 days (1 to 44 days). All the catheters were inserted & cared by experienced staff at the bedside via right or left subclavian vein (87%: 13%). Acute complications included mediastinal hematoma in 1 case (1.4%), and local hematoma or persisting bleeding in 2 cases (2.7%), but there was no pneumothorax or hemothorax. Chronic complications included inadequate flow or occlusion of lumen in 13 cases (17.6%), and local infection in 6 cases (8.1%) with 1 case of bacteremia and 2 cases of fungemia. Until June 1991, 10 patients received digital subtraction angiography (DSA) of upper limb vein about ito 22 months (mean: 7±6 months) after catheter removal. Severe subclavian vein stenosis or occlusion was found in 3 patients (30%). We conclude that SCVC is a safe and convenient method as temporary access for hemodialysis, and that preoperative DSA for subclavian vein is mandatory to document the patency of subclvain vein in the patients who have previously received SCVC if ipsilateral AV fistula or graft is planned.