目的 观察并发上腔静脉血栓的隧道式cuff透析导管(tunneled cuffed dialysis catheters,TCC)行原位导管更换时症状性肺栓塞的发生率及转归情况. 方法 回顾性分析四川大学华西医院2015年1月～2016年9月因TCC功能障碍在DSA(digital subtraction angiography,DSA)引导下行原位导管更换的、并发上腔静脉血栓的维持血液透析患者31例.记录患者术中及术后24h出现胸闷、胸痛、呼吸困难、咯血、心率增快、血压下降及血氧饱和度下降等急性肺栓塞相关症状的发生例数,对有症状的患者进行胸部血管CT造影(computed tomograpby angiography,CTA)检查,明确是否存在肺栓塞.结果 本研究共纳入31例患者,平均年龄(64.16±15.77)岁,女性23例(74.19％),男性8例(25.81％).出现急性肺栓塞相关症状的病例共9例(29.03％):6例存在不同程度的呼吸困难症状,其中,2例合并胸闷症状,1例合并心率增快及一过性的血氧饱和度降低;3例心率增快;无患者发生胸痛、咯血及血压降低情况.行胸部血管CTA检查仅发现1例(1/9)存在肺栓塞.对所有研究对象进行电话随访无1例死亡.结论 并发上腔静脉血栓的TCC在DSA引导下进行原位换管是相对安全的,其所致的症状性肺栓塞及严重不良后果的发生率低.%Objective To analyze the incidence and prognosis of symptomatic pulmonary embolism due to the operation of wire-guided exchange of tunneled cuffed dialysis catheters (TCC) with superior vena cava thrombosis.Methods We retrospectively analyzed 31 patients undergoing hemodialysis using TCC as the long-term vascular access and complicated with superior vena cava thrombosis in West China Hospital of Sichuan University from January 2015 to September 2016.These patients were treated with wire-guided exchange of TCC under the guidance of digital subtraction angiography (DSA) because of the TCC dysfunction.Symptoms of acute pulmonary embolism,such as chest tightness,chest pain,dyspnea,hemoptysis,accelerated heart rate,hypotension and lower oxygen saturation were recorded during the operation and after the operation for 24 hours.Thoracic CT angiography (CTA) was performed for the symptomatic patients to determine whether pulmonary embolism happened.Results A total of 31 patients with the average age of 64.16 ±15.77 years old were enrolled in this study.Nine patients (29.03％) presented with pulmonary embolism related symptoms:6 cases with different degrees of dyspnea,in which 2 patients felt chest tightness and one case had accelerated heart rate and transient lowering of oxygen saturation;3 cases with accelerated heart rate.No patients had chest pain,hemoptysis and hypotension.Thoracic CTA examination revealed pulmonary embolism in one case (1/9).All patients were followed up by telephone,and no one died.Conclusions Wire-guided exchange of TCC under the guidance of DSA for the patients with TCC complicated with superior vena cava thrombosis is relatively safe.The incidence of symptomatic pulmonary embolism and severe adverse consequences is low.
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