脐血管导管断裂1例并文献复习  

Umbilical vascular catheter rupture:a case report and literature review

作　　者：谢楠辉 李芳婷 陈基华 谭宝莹 刘郴州 Xie Nanhui;Li Fangting;Chen Jihua;Tan Baoying;Liu Chenzhou(Guangdong Medical University,Zhanjiang 524023,China;Zunyi Medical University,Zunyi 563000,China;Department of Cardiology,Jiangmen Clinical College of Medicine,Guangdong Medical University,Jiangmen Central Hospital,Jiangmen 529030,China;Department of Pediatric Intensive Care Unit,Jiangmen Clinical College of Medicine,Guangdong Medical University,Jiangmen Central Hospital,Jiangmen 529030,China)

机构地区：[1]广东医科大学,湛江524023 [2]遵义医科大学,遵义563000 [3]广东医科大学江门临床医学院/江门市中心医院心血管内科,江门529030 [4]广东医科大学江门临床医学院/江门市中心医院儿科重症监护病区,江门529030

出　　处：《中华新生儿科杂志（中英文）》2023年第5期267-271,共5页Chinese Journal of Neonatology

摘　　要：目的分析新生儿脐血管导管断裂的临床特点,总结临床经验。方法回顾性分析江门市中心医院新生儿科收治的1例脐静脉导管断裂患儿诊疗经过。以"脐静脉导管、脐静脉置管"、"脐动脉导管、脐动脉置管"、"导管断裂"、"umbilical vein catheter"、"umbilical arterial catheter"、"catheter rupture"为检索词,分别对中华医学期刊网、中国知网、万方数据库、维普数据库、PubMed、Web of Science、Embase、Cochrane Library自建库至2022年3月15日收录的文献进行检索,分析新生儿脐血管导管断裂的原因、处理方法及预后。结果本例患儿因移除结扎缝线时不慎损伤脐静脉导管,稍用力拔管后出现导管断裂,造成约7 cm导管残端遗留体内,经脐静脉血管介入术,在X线引导下使用圈套器成功取出。文献检索共纳入国外文献15篇33例(国内无相关病例报道),加上本例共34例,包含脐动脉、脐静脉导管断裂。16例(47.1%)移除导管时不慎被刀、剪切断,3例(8.8%)在留置导管时发生断裂,1例(2.9%)在高压冲管后断裂,14例(41.2%)导管断裂原因不详。9例(26.5%)出现呼吸窘迫、心脏杂音增强、败血症、肢体缺血等,20例(58.8%)无临床表现,5例(14.7%)临床表现不详。21例(61.8%)通过血管介入术取出,11例(32.4%)通过外科手术取出,1例(2.9%)应用镊子取出,1例(2.9%)因患儿死亡未取出。外科手术取管患儿中,1例因败血症术后第2天死亡,1例缺血肢体遗留后遗症;2例血管介入术取管患儿术后血管痉挛、栓塞,后续恢复良好。结论新生儿脐血管导管断裂是一种罕见的并发症,其发生多与刀、剪损伤有关,多用血管介入方式取出导管。Objective To study the clinical characteristics of neonatal umbilical vascular catheter(UVC)rupture.Methods A neonate with UVC rupture admitted to Neonatology Department of our hospital was retrospectively reviewed.Literature on this subject were searched in the following databases:Chinese Medical Journal full-text Database,CNKI,Wanfang Database,CQVIP database,PubMed,Web of Science,Embase and Cochrane Library(up until March 152022).The causes,treatment and prognosis of neonatal UVC rupture were analyzed.Results In our case,the UVC was accidentally damaged during the removal of the ligature suture.The UVC was ruptured after a slight force was applied to remove the catheter,resulting in approximately 7 cm of UVC remaining in the body.Trans-umbilical vein intervention was performed and the catheter was successfully removed with a lasso under X-ray guidance.A total of 33 UVC rupture cases were included from 15 articles(no case report in China before).In 16 cases(47.1%),the UVCs were accidentally cut off by knife or scissors when removing the catheter.In 3 cases(8.8%),the UVCs were broken during insertion.The UVC was broken in 1 case(2.9%)during flushing the catheter.The causes of the other 14 cases(41.2%)were unknown.9 cases(26.5%)had clinical manifestations,including respiratory distress,prominent heart murmur,sepsis and limb ischemia.20 cases(58.8%)showed no clinical features.No data on the other 5 cases(14.7%).21 cases(61.8%)received vascular intervention removal,11 cases(32.4%)received surgical removal,1 case(2.9%)was removed with tweezers,and 1 case(2.9%)died before UVC was removed.Among the neonates receiving surgical treatment,1 case died of sepsis on the second day after surgery and 1 case had sequela of limb ischemia.2 cases had postoperative vasospasm and embolism after vascular intervention with overall good prognosis.Conclusions The rupture of UVC in neonates is rare and mainly related with knife and scissors injury.

关 键 词：脐血管导管 并发症 导管断裂 新生儿 

分 类 号：R722.1[医药卫生—儿科]