婴儿中心静脉导管相关性深静脉血栓的特征。
Characterization of central venous catheter-associated deep venous thrombosis in infants.
机构信息
Section of Pediatric Surgery, C.S. Mott Children's Hospital, University of Michigan Health System, Ann Arbor, MI 48109, USA.
出版信息
J Pediatr Surg. 2012 Jun;47(6):1159-66. doi: 10.1016/j.jpedsurg.2012.03.043.
PURPOSE
Deep venous thrombosis (DVT) is a frequent complication in infants with central venous catheters (CVCs). We performed this study to identify risk factors and risk-reduction strategies of CVC-associated DVT in infants.
METHODS
Infants younger than 1 year who had a CVC placed at our center from 2005 to 2009 were reviewed. Patients with ultrasonically diagnosed DVT were compared to those without radiographic evidence.
RESULTS
Of 333 patients, 47% (155/333) had femoral, 33% (111/333) had jugular, and 19% (64/333) had subclavian CVCs. Deep venous thromboses occurred in 18% (60/333) of patients. Sixty percent (36/60) of DVTs were in femoral veins. Femoral CVCs were associated with greater DVT rates (27%; 42/155) than jugular (11%; 12/111) or subclavian CVCs (9%; 6/64; P < .01). There was a 16% DVT rate in those with saphenofemoral Broviac CVCs vs 83% (20/24) in those with percutaneous femoral lines (P < .01). Multilumen CVCs had higher DVT rates than did single-lumen CVCs (54% vs 6%, P < .01), and mean catheter days before DVT diagnosis was shorter for percutaneous lines than Broviacs (13 ± 17 days vs 30 ± 37 days, P = .02). Patients with +DVT had longer length of stay (86 ± 88 days vs 48 ± 48 days, P < .01) and higher percentage of intensive care unit admission (82% vs 70%, P = .02).
CONCLUSIONS
Deep venous thrombosis reduction strategies in infants with CVCs include avoiding percutaneous femoral and multilumen CVCs, screening percutaneous lines, and early catheter removal.
目的
深静脉血栓形成（DVT）是中心静脉导管（CVC）置管婴儿的常见并发症。我们进行本研究以确定与 CVC 相关的 DVT 的危险因素和降低风险策略。
方法
回顾 2005 年至 2009 年在我院接受 CVC 置管的 1 岁以下婴儿。将超声诊断为 DVT 的患者与无放射学证据的患者进行比较。
结果
在 333 例患者中，47%（155/333）为股静脉，33%（111/333）为颈静脉，19%（64/333）为锁骨下静脉。333 例患者中有 18%（60/333）发生深静脉血栓形成。60%（36/60）的 DVT 位于股静脉。股静脉 CVC 与更高的 DVT 发生率（27%；42/155）相关，而颈静脉（11%；12/111）或锁骨下静脉（9%；6/64；P<.01）则较低。股动静脉 Broviac 导管组的 DVT 发生率为 16%，而经皮股静脉置管组的 DVT 发生率为 83%（20/24）（P<.01）。多腔 CVC 的 DVT 发生率高于单腔 CVC（54% vs 6%，P<.01），经皮股静脉置管组的导管使用天数较 Broviac 导管组更短（13±17 天 vs 30±37 天，P=0.02）。DVT 患者的住院时间更长（86±88 天 vs 48±48 天，P<.01），入住重症监护病房的比例更高（82% vs 70%，P=0.02）。
结论
CVC 置管婴儿的深静脉血栓形成降低策略包括避免经皮股静脉和多腔 CVC、筛查经皮股静脉置管和尽早拔管。
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