干旱区生态环境知识资源中心(Arid): 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

Arid

	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
其他题名	Central venous catheter-related thrombosis in critically ill patients: a prospective observational study by ultrasonography
	蔡书翰 1; 谢钦 1; 赵玉乾 1; 张雪艳 2; 李志峰 1; 彭志勇 1
来源期刊	中国中西医结合急救杂志
ISSN	1008-9691
出版年	2019
卷号	26 期号:2 页码:167-170
中文摘要	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)或经颈内静脉置人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均在导管置人后3 d内形成,9例(81.8%)在置管后1 d发现,另2例(18.2%)在置管后3d发现。SCCVC组CRT发生率〔5.7%(5/88)比17.1%(6/35),P<0.05〕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)。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通常发生在导管置人后早期,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。
英文摘要	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 nonanticoagulation 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 oases 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, although there were no statistically significant differences. The CRT usually occurs within 3 days after the catheter insertion. Frequent bedside ultrasonography in the first 3 days after catheterization can confirm the diagnosis and guide clinical treatment.
中文关键词	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
英文关键词	Central venous catheter Central venous catheter-related thrombosis Internal jugular venous catheter Subclavian venous catheter UItrasound
语种	中文
国家	中国
收录类别	CSCD
WOS类目	MEDICINE GENERAL INTERNAL
WOS研究方向	General & Internal Medicine
CSCD记录号	CSCD:6501679
资源类型	期刊论文
条目标识符	http://119.78.100.177/qdio/handle/2XILL650/239844
作者单位	1.武汉大学中南医院重症医学科, 武汉, 湖北 430071, 中国; 2.河南省人民医院重症医学科, 郑州, 河南 450003, 中国
推荐引用方式 GB/T 7714	蔡书翰,谢钦,赵玉乾,等. 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[J],2019,26(2):167-170.
APA	蔡书翰,谢钦,赵玉乾,张雪艳,李志峰,&彭志勇.(2019).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.中国中西医结合急救杂志,26(2),167-170.
MLA	蔡书翰,et al."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".中国中西医结合急救杂志 26.2(2019):167-170.