Jeanneteau J, Braud O, Pinaud F, Faraj S, Gillet S, Cottineau C, de Brux J-L, Baufreton C
Service de cardiologie, pôle cardiovasculaire, faculté de médecine d'Angers, CHU d'Angers, université d'Angers, 4, rue Larrey, 49933 Angers cedex, France.
Ann Fr Anesth Reanim. 2009 Apr;28(4):291-6. doi: 10.1016/j.annfar.2009.01.023. Epub 2009 Mar 18.
Insertion of Swan-Ganz catheter for a few days may be necessary in cardiac surgery. This study was aimed at determining the incidence and the evolution of thrombotic images within the internal jugular vein as well as assessing their association with the presence of a prolonged fever at postoperative day 7 in the lack of any documented infection.
All the patients undergoing cardiac surgery had a two-dimensional ultrasonography of internal jugular veins preoperatively, at discharge (day 7) and at postoperative day 90 if thrombotic images were seen at day 7.
Sleeve-like and compact thrombotic images have been observed in site of venipuncture in 52 patients (70.3%). None had any residual thrombotic image 90 days after the operation. No clinical thromboembolic migration has been observed. There was no statistical association between the presence of a thrombotic image at the ultrasonography and the duration of catheterization. Moreover, there was no association between the anticoagulation before, during and after the surgery and the presence of a thrombotic image. We found a non-significant association between fever at day 7 and the presence of a thrombotic image within the internal jugular vein.
Thrombotic images in the internal jugular vein after catheterization are frequent and disappear at day 90. The limited sample size of this study does not provide strong evidence of the role of jugular thrombi in the prolongation of fever after cardiac surgery.
心脏手术中可能需要插入Swan - Ganz导管数天。本研究旨在确定颈内静脉内血栓形成影像的发生率及演变情况,并评估在无任何感染记录的情况下,其与术后第7天持续发热的相关性。
所有接受心脏手术的患者在术前、出院时(第7天)以及如果在第7天发现血栓形成影像则在术后第90天均接受颈内静脉二维超声检查。
在52例患者(70.3%)的静脉穿刺部位观察到袖状和致密的血栓形成影像。术后90天无一例有残留血栓形成影像。未观察到临床血栓栓塞性迁移。超声检查时血栓形成影像的存在与导管插入持续时间之间无统计学关联。此外,手术前、手术期间和手术后的抗凝与血栓形成影像的存在之间也无关联。我们发现第7天的发热与颈内静脉内血栓形成影像的存在之间存在非显著关联。
导管插入后颈内静脉血栓形成影像很常见,且在第90天消失。本研究有限的样本量并未提供有力证据证明颈静脉血栓在心脏手术后发热延长中的作用。