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透析通路相关的中心静脉狭窄

Author
Gerald A Beathard, MD, PhD
Section Editor
Steve J Schwab, MD
Deputy Editor
Kathryn A Collins, MD, PhD, FACS
Translators
罗福文, 主任医师，教授

引言

向中心静脉内引入外源性留置物导致中心静脉狭窄的发生。在透析患者中，主要关注已指向留置导管是这一问题的病因[1-4]。

然而，心内留置线以及上肢经外周静脉置入中心静脉导管(peripherally inserted central venous catheter,PICC)也可能是病因[5-9]。中心静脉狭窄的其他情况可能出现于因扩张的主动脉对左头臂静脉的外部压迫[10]，但一些中心静脉狭窄的发生无明确前驱事件[11,12]。

中心静脉狭窄引起的问题主要与流向受累中心静脉的同侧周围透析通路的存在相关。患者通路侧手臂常出现迅速增加的大面积水肿，伴有疼痛和不适(常在透析期间加重)。中心静脉狭窄的预防有赖于避免使用中心静脉透析导管，尤其是避免使用锁骨下穿刺导管，锁骨下穿刺导管是这一并发症的主要原因。

透析通路相关的中心静脉狭窄的详细讨论见此专题。使用血液透析导管的患者中观察到的血栓形成见其他专题。 (参见“Thrombosis associated with chronic hemodialysis vascular catheters”)

病因和发病率

尽管中心静脉狭窄可在无明确前驱事件的情况下发生，但其主要还是与中心导管的应用相关。局灶性内皮剥脱相关的早期内膜损伤发生在短期应用中心静脉导管时[13]。静脉壁增厚、平滑肌细胞增多、导管局部附着于具有血栓和胶原的静脉壁发生在长期应用导管时。

               

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Literature review current through: 2017-06 . | This topic last updated: 2017-05-18.
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