【摘要】目的探讨DSA(digital subtraction angiography)引导下左侧颈内静脉置管判定皮下隧道长度的方法方法44 例维持性血液透析患者，22 例为实验组，左侧颈内静脉穿刺留置导管鞘，DSA 引导下置入血管内造影导管，使导管头端位于右心房中上部，在体外标记造影导管出导管鞘位置，撤出造影导管，测量导管进入体内的长度。根据这个长度确定带CUFF 透析导管皮下隧道长度。22 例为对照组，粗略根据体表骨性标记物确定带CUFF 透析导管皮下隧道长度。结果实验组22 例患者左侧颈内静脉置管后导管尖端均位于右心房中部或者中上部，皮下隧道无过长或过短情况发生。对照组导管尖端14 例位于心房中部或者中上部、7 例位于心房下部，1 例位于上腔静脉近心房处。所有患者术后当日或者次日透析，血流量均在250ml/min 以上。术后6 个月内，44 例患者当中3 例导管尖端明显上移，其中女性2 例，男性1 例。39 例导管尖端轻度上移，2 例无明显上移，对照组1 例CUFF 脱出更换导管。结论DSA 引导下预先置入血管内造影导管测量的方法可以较准确地确定左侧颈内静脉置管皮下隧道长度，左侧颈内静脉带CUFF导管置入术后多有管尖轻度上移现象。

【Abstract】Objective To study the determination method of subcutaneous tunnel length during left internal jugular vein catheterization under the guidance of digital subtraction angiography (DSA). Methods Forty- four maintenance hemodialysis patients were enrolled in this study. In the experimental group (n=22), catheter sheath was indwelled after puncture of left internal jugular vein. The 4F endovascular angiographic catheter was then inserted through the catheter sheath under the guidance of DSA, ensuring that the catheter tip was located in the middle upper part of right atrium. The site of angiographic catheter out of the catheter sheath was labeled on body surface. The angiographic catheter was then withdrawn and the length of the catheter entering the body was measured. Based on this length, subcutaneous tunnel length of the dialysis catheter with cuff was determined. In the control group (n=22), subcutaneous tunnel length of the dialysis catheter with cuff was roughly determined by the osseous marker on body surface. Results In the 22 patients in experimental group, the tips of left internal jugular vein catheters were located in middle or middle upper part of right atrium. The subcutaneous tunnel length was appropriate and no longer or shorter length occurred. In the 22 patients in control group, the tips of the catheters were located in middle or middle upper part of atrium in 14 cases, in inferior atrium in 7 cases and in superior vena cava near atrium in one case. The dialysis blood flow was >250 ml/min in all cases on the day of operation and the second day. Within 6 months after operation, catheter tips moved upward in 3 cases (two females and one male). Catheter tips moved slightly upward in 39 of the 44 cases. The dialysis catheter slipped out and must be replaced in one case in control group. Conclusions The subcutaneous tunnel length during left internal jugular vein catheterization can be accurately determined through insertion of an endovascular angiographic catheter under the guidance of DSA. Most of the tip of dialysis catheter with cuff via left internal jugular vein may move upward slightly after catheterization.