Technical specification of blood purification in organ transplantation (2019 edition)
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摘要: 为了进一步规范器官移植相关血液净化的临床技术操作,中华医学会器官移植学分会组织器官移植学专家和肾内科专家从血管通路、血液透析、腹膜透析、血液滤过、血浆置换和免疫吸附的技术操作规范等方面,制订本规范。Abstract: In order to further standardize the clinical technical operation of blood purification related to organ transplantation, experts in the fields of organ transplantation and nephrology organized by Branch of Organ Transplantation of Chinese Medical Association have formulated this specification from the perspectives of technical operation specifications of vascular access, hemodialysis, peritoneal dialysis, hemofiltration, plasma exchange and immunoadsorption.
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Key words:
- Organ transplantation /
- Hemodialysis /
- Peritoneal dialysis /
- Hemofiltration /
- Plasma exchange /
- Immunoadsorption /
- Blood purification
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表 1 3种经皮中心静脉穿刺插管方法的特点比较[6]
Table 1. Comparison of characteristics of percutaneous central veinpuncture catheterization among three methods
特点 股静脉 锁骨下静脉 颈内静脉 操作技术 容易插管 需要较高的技术和经验 比锁骨下静脉插管容易 穿刺并发症 并发症少,而且轻 可能发生严重并发症,如血气胸 并发症发生率较低 保留时间 一般72 h拔除,否则感染率很高 可保留3~4周 可保留3~4周或更久 体位 心力衰竭呼吸困难者不能平卧时采用 需要头后仰体位 需要头后仰体位 活动情况 置管后,患者常卧床,不方便行走 患者可以自由活动,可做门诊透析 头颈部运动可受限,用弯头导管可以改善 血流情况 可以获得较好血流,常与大腿位置有明显关系 可获得很好血流 可以获得很好血流 留置并发症 缺少长期保留导管的临床观察经验(通常短期内拔管),血栓发生率和不畅率很高 锁骨下静脉血栓和狭窄发生率高 狭窄发生率很低,血栓发生率同锁骨下静脉 -
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