Moosa H H, Julian T B, Rosenfeld C S, Shadduck R K
Department of Surgery, Montefiore University Hospital, University of Pittsburgh School of Medicine, Pennsylvania 15213.
Surg Gynecol Obstet. 1991 Apr;172(4):275-9.
Complications associated with indwelling central venous catheters in patients undergoing bone marrow transplantation are presented. The study group was comprised of 123 patients who underwent transplantation from 1982 to 1988 in whom 139 catheters were placed. One hundred and fifteen of 139 catheters placed had a triple lumen, while 24 had a dual lumen. Percutaneous placement through the subclavian vein was used in 127 of 139 catheters with a low complication rate. Catheters remained in place for 65.0 +/- 55.5 days (mean +/- standard deviation). One hundred and eight catheters remained functional during the course of treatment for these patients and lasted until elective removal or until the patient died. Thirty-one catheters were removed because of a complication. Infection was the most common complication, occurring in 22 catheters. Seven infected catheters were salvaged with antibiotic therapy. Coagulase negative staphylococcus was the most frequent organism identified. Mechanical problems causing catheter malfunction, migration, thrombosis and cuff erosion occurred in 19 catheters; 15 were removed. We concluded that double and triple lumen Silastic (silicone rubber) catheters provide relatively safe and effective access for bone marrow transplant recipients. The triple lumen catheter provides an additional venous access port that facilitates intensive care. The duration of catheter function is sufficient in most patients for therapy during and after bone marrow transplantation. Infection is the most common complication; our results indicate that catheters can be maintained and salvaged in some patients with septicemia. Noninfectious complications are less frequent, although catheters with persistent mechanical problems are less likely to be salvaged.
本文介绍了骨髓移植患者留置中心静脉导管相关的并发症。研究组由1982年至1988年间接受移植的123例患者组成，共置入139根导管。139根置入的导管中，115根为三腔导管，24根为双腔导管。139根导管中有127根经锁骨下静脉经皮置入，并发症发生率较低。导管留置时间为65.0±55.5天（平均值±标准差）。108根导管在这些患者的治疗过程中保持功能，直至择期拔除或患者死亡。31根导管因并发症而拔除。感染是最常见的并发症，发生在22根导管。7根感染导管经抗生素治疗得以挽救。凝固酶阴性葡萄球菌是最常鉴定出的病原体。19根导管出现导致导管功能障碍、移位、血栓形成和袖套侵蚀的机械问题；15根被拔除。我们得出结论，双腔和三腔硅橡胶导管为骨髓移植受者提供了相对安全有效的通路。三腔导管提供了额外的静脉通路端口，便于重症监护。大多数患者导管功能持续时间足以满足骨髓移植期间及之后的治疗。感染是最常见的并发症；我们的结果表明，一些败血症患者的导管可以维持并挽救。非感染性并发症较少见，尽管存在持续性机械问题的导管挽救的可能性较小。
