采用超声筛查重症患者中心静脉导管血栓形成的观察性研究  

Central venous catheter-related thrombosis in critically ill patients: a prospective observational study by ultrasonography

作　　者：蔡书翰[1] 谢钦 赵玉乾 张雪艳[2] 李志峰[1] 彭志勇[1] Cai Shuhan;Xie Qin;Zhao Yuqian;Zhang Xueyan;Li Zhifeng;Peng Zhiyong(Department of Critical Care Medicine,Zhongnan Hospital of Wuhan University,Wuhan 430071,Hubei,China;Department of Critical Care Medicine,Henan Provincial People's Hospital,Zhengzhou 450003,Henan,China)

机构地区：[1]武汉大学中南医院重症医学科,湖北武汉430071 [2]河南省人民医院重症医学科,河南郑州450003

出　　处：《中国中西医结合急救杂志》2019年第2期167-170,共4页Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care

基　　金：武汉大学中南医院院内人才引进科研启动基金(20160103).

摘　　要：目的通过超声筛查重症患者中心静脉导管(CVC)周围血栓的发生情况,比较不同置管部位导管相关性血栓(CRT)的发生率,并分析影响血栓形成的因素。方法选取2015年5月至12月入住武汉大学中南医院重症医学科(ICU)且经锁骨下静脉置入CVC(SCCVC)或经颈内静脉置入CVC(IJCVC)的123例患者为研究对象,将患者按置管部位的不同分为IJCVC组(35例)和SCCVC组(88例),按是否接受手术治疗分为手术组(85例)和非手术组(38例),按是否使用抗凝治疗分为抗凝组(25例)和非抗凝组(98例)。在患者住ICU期间每日通过超声观察患者体内CRT的发生率。结果纳入123例患者中11例(8.9%)发现CRT,发生率为22.1例/千日。所有CRT均在导管置入后3d内形成,9例(81.8%)在置管后1d发现,另2例(18.2%)在置管后3d发现。SCCVC组CRT发生率〔5.7%⑸88)比17.1%(6/35),PV0.05〕和千日CRT发生率(例/千日:12.6和59.4)均明显低于IJCVC组。手术组与非手术组CRT发生率〔11.8%(10/85)比2.6%(1/38)〕、抗凝组和非抗凝组CRT发生率[8.0%(1/25)比9.2%(2/98)〕比较差异均无统计学意义(均P>0.05)c结论IJCVC的CRT发生率为SCCVC的3倍,抗凝剂或外科手术对CRT的发生率会有影响,但差异无统计学意义。CRT通常发生在导管置入后早期,置管后前3d频繁进行床旁超声检查可明确诊断,从而指导临床治疗。Objective Doppler ultrasonography was used to screen the incidence of central venous catheter (CVC) thrombosis in severe patients to observe the incidences of catheter related thrombosis (CRT) at subclavian (SC) and internal jugular (IJ) venous insertion sites, and to analyze the factors affecting the thrombosis. Methods One hundred and twenty three adult patients with IJ or SC CVC admitted to the Department of Intensive Care Unit (ICU) of Zhongnan Hospital of Wuhan University from May to December 2015 were enrolled to be the research objects, they were divided into an IJCVC group (35 cases) and a SCCVC group (88 cases) according to different catheterization sites;they were divided into an operation group (85 cases) and a non-operation group (38 cases) according to whether operation was performed or not;and they were also divided into an anticoagulation group (25 cases) and a non- anticoagulation group (98 cases) according to whether anticoagulation therapy was used or not. Doppler ultrasonography was performed every day to observe the incidences of CRT during ICU stay. Results One hundred and twenty-three patients were included in this study. CRT was detected in 11 (8.9%) patients, with an incidence of 22.1 per 1 000 catheter-days. All the 11 cases with CRT were presented within 3 days after the insertion, with 9 cases (81.8%) on the first day and 2 cases (18.2%) on the third day. The incidence of CRT in SCCVC group was significantly lower than that in IJCVC group [5.7%(5/88) vs. 17.1%(6/35), P < 0.05], with the rates of 12.6 and 59.4 per 1 000 catheter-days, respectively. There were no statistical significant differences in the incidences of CRT between operation group and non-operation group [11.8%(10/85) vs. 2.6%(1/38)], and between anticoagulation group and non-anticoagulation group [8.0%(1/25) vs. 9.2%(2/98), both P > 0.05]. Conclusions The incidence of CRT at IJCVC site is estimated to be 3-times higher than that at SCCVC site, anticoagulants or surgical operation may have impacts on the incidence of CRT,

关 键 词：中心静脉导管 中心静脉导管相关性血栓 颈内静脉导管 锁骨下静脉导管 超声 

分 类 号：R472.9[医药卫生—护理学]