锁骨下静脉置管内血栓形成危险因素分析及探讨  

Risk factors analysis for thrombosis in subclavian deep vein catheterization

作　　者：高林英 韦键[1] 魏红涛[1] 丛雪 张倩 GAO Lin-ying;WEI Jian;WEI Hong-tao(Digestive Endoscopy Center,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China)

机构地区：[1]首都医科大学附属北京友谊医院消化分中心,北京100050

出　　处：《临床和实验医学杂志》2023年第21期2285-2289,共5页Journal of Clinical and Experimental Medicine

摘　　要：目的分析深静脉置管发生血栓的临床特征,探讨锁骨下深静脉置管内血栓形成的危险因素,为制定输液导管相关性血栓预防方案提供依据。方法回顾性纳入2021年2月至2022年10月在首都医科大学附属北京友谊医院消化科住院并接受超声引导下锁骨下静脉穿刺,置入Arrow抗感染中心静脉导管的138例患者为研究对象。入组患者按照导管内是否有血栓分为血栓组(n=98)和无血栓组(n=40)。收集患者基本信息、既往史、置管和血栓情况、置管前后血常规、血生化、凝血功能信息,以及患者日常生活活动能力Barthel指数量表、Branden压力伤风险评估量表和Padua静脉血栓风险评估模型评分,采用多因素Logistic回归分析影响导管内血栓形成的危险因素。结果血栓组和无血栓组患者的基本信息与既往史比较,差异均无统计学意义(P>0.05)。血栓组的深静脉置管中位留置时间为12(8~16)d,无血栓组的中位留置时间为10(6.5~13.0)d,血栓组留置时间长于无血栓组,差异有统计学意义(P<0.05)。血栓组静脉滴注高凝药品率为23.5%,高于无血栓组(5.0%),差异有统计学意义(P<0.05)。多因素Logistic回归结果提示,深静脉置管留置时间越长(OR=1.143,95%CI:1.047~1.249,P=0.003)、置管后白细胞数越高(OR=1.206,95%CI:1.021~1.423,P=0.027),血栓发生可能性越大。结论深静脉置管留置时间长和置管后白细胞数升高是血栓发生的独立危险因素。深静脉置管后,应关注留置时间较长、置管后白细胞数较高的患者发生血栓的危险性。Objective To analyze the clinical characteristics of deep vein catheterization thrombosis,to explore the risk factors of subclavian deep vein catheterization thrombosis,and to provide a program for the prevention of infusion catheter-related thrombosis.Methods A total of 138 patients receiving ultrasound-guided subclavian vein and Ultrasound guided subclavian vein puncture and arrow anti-infective central venous catheter placement were retrospectively enrolled as the subject in Beijing Friendship Hospital,Capital Medical University from February 2022 to October 2022.The patients were divided into thrombus group(n=98)and non-thrombus group(n=40)according to whether there was thrombus in the catheter.Demographic characteristics,disease history,catheter and thrombus status,routine blood test before and after catheter,blood biochemistry and coagulation function information,Barthel index rating scale,Branden stress injury risk assessment scale and Padua venous thrombosis risk assessment model were collected.Multivariate Logistic regression analysis was used to analyze the risk factors of catheter thrombosis.Results There were no statistically significant differences in demographic characteristics and disease history between thrombus group and non-thrombus group(P>0.05).The median indwelling time for deep venous catheterization was 12(8-16)days in the thrombotic group and 10(6.5-13.0)days in the non-thrombus group.The indwelling time in the thrombus group was longer than that in the non-thrombus group,the difference was statistically significant(P<0.05).The rate of hypercoagulable drugs in thrombus group was 23.5%,which was higher than that in the non-thrombus group(5.0%),the difference was statistically significant(P<0.05).Multivariate Logistic regression analysis showed that the probability of thrombosis increased with longer duration of indwelling catheter(OR=1.143,95%CI:1.047-1.249,P=0.003)and higher white blood cell count after indwelling catheter(OR=1.206,95%CI:1.021-1.423,P=0.027).Conclusion Long duration of ind

关 键 词：锁骨下静脉 导管置入术 中心静脉 危险因素 血栓 

分 类 号：R543.6[医药卫生—心血管疾病]