血栓弹力图联合床旁B超指导预防颈内静脉置管后血栓形成的价值研究  

Application of thromboelastography combined with point-of-care ultrasound to prevent internal jugular vein catheterization related thrombosis

作　　者：骆月琴[1] 周明[1] 王柏磊[2] Luo Yueqin;Zhou Ming;Wang Bolei(Department of Critical Medicine,Beihai People's Hospital,Beihai 536000,Guangxi Zhuang Autonomous Region,China)

机构地区：[1]北海市人民医院重症医学科,广西壮族自治区北海536000 [2]北海市人民医院急诊科,广西壮族自治区北海536000

出　　处：《中华危重病急救医学》2020年第8期994-997,共4页Chinese Critical Care Medicine

基　　金：北海市科学研究与技术开发计划项目(北科合201803004)。

摘　　要：目的探讨血栓弹力图(TEG)联合床旁B超指导预防颈内静脉置管后血栓形成的效果.方法选择2018年12月至2020年4月北海市人民医院重症医学科收治的需留置颈内静脉导管的患者,按随机数字表法将患者分为两组.联合置管组在置管前B超检查双侧颈内静脉,选择内径较大、充盈良好的血管及部位置管,若双侧颈内静脉均不充盈,补液改善后再穿刺;同时在TEG监测下根据凝血功能及出血风险选择抗凝、抗血小板或降低血黏度等药物抗栓;每日B超监测置管颈内静脉的血流动力学状态,发现置管静脉塌陷或血流缓慢,则查找原因并予以改善,一旦发现血栓形成,拔除导管.常规置管组优先选择右侧颈内静脉并根据体表标志穿刺置管.两组其他治疗均按常规方案执行.记录患者颈内静脉置管后血栓形成及出血风险情况.结果最终纳入97例患者,其中联合置管组51例,常规置管组46例,两组患者性别、年龄、急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)、深静脉血栓风险评分(Caprini)、CRUSADE出血风险评分、高出血风险比例、疾病类型、凝血障碍比例、置管时间等比较差异均无统计学意义,但联合置管组抗凝治疗比例高于常规置管组(66.7%比30.4%,P<0.01),且血栓发生率也低于常规置管组(39.2%比78.3%,P<0.01),形成的血栓也明显小于常规置管组〔cm3:0.077(0.047,0.089)比0.341(0.070,0.378),P<0.01〕.两组患者治疗过程中均无大出血事件发生.结论基于TEG及床旁B超指导下的集束化抗栓措施能降低颈内静脉置管后血栓发生率,且形成的血栓较小,未增加出血风险,值得临床推广应用.Objective To investigate the effect of thromboelastography(TEG)combined with point-of-care ultrasound(POCUS)guidance on the prevention of internal jugular vein catheterization related thrombosis.Methods The patients who required internal jugular vein catheterization admitted to the department of critical medicine of Beihai People's Hospital from December 2018 to April 2020 were enrolled.Patients were divided into two groups according to the random number table method.For the combined cathetherization group,ultrasound was used to examine bilateral internal jugular veins before catheterization.The larger diameter and better filled vein and site were selected for puncture.If both internal jugular veins were not fulfilled well,puncture were performed after fluid administration.At the same time,anticoagulant,antiplatelet or reducing blood viscosity drugs were used according to coagulation function and bleeding risk under the monitoring of TEG.The hemodynamic state of the internal jugular vein was monitored by ultrasound every day.If the vein collapsed or the blood flow was slow,the cause should be tried to be found and improved.Once thrombosis was found,the catheter should be removed.For the routine cathetherization group,the right side internal jugular vein was prior to be punctured according to body surface symbols.The other treatment of the two groups were the same as routine treatment.The conditions of thrombosis and bleeding were recorded.Results Ninety-seven patients were selected,51 cases in the combined cathetherization group and 46 cases in the routine cathetherization group.There was no significant differences in gender,age,acute physiology and chronic health evaluationⅡ(APACHEⅡ),risk of deep vein thrombosis score(Caprini),CRUSADE bleeding risk score,the proportion of high bleeding risk,disease types,the proportion of coagulation disorder and catheterization time between the two groups,but the anticoagulation treatment proportion in the combined cathetherization group was higher than that in the routine

关 键 词：血栓弹力图 B超 血栓形成 颈内静脉 

分 类 号：R459.7[医药卫生—急诊医学]