Singh Shweta A, Sharma Sandeep, Singh Anshuman, Singh Anil K, Sharma Utpal, Bhadoria Ajeet Singh
Department of Anesthesiology and Critical Care, Institute of Liver and Biliary Science, Vasant Kunj, New Delhi, India.
Department of Clinical Research, Institute of Liver and Biliary Science, Vasant Kunj, New Delhi, India.
Saudi J Anaesth. 2015 Apr-Jun;9(2):155-60. doi: 10.4103/1658-354X.152842.
Central venous cannulation (CVC) is frequently required during the management of patients with liver disease with deranged conventional coagulation parameters (CCP). Since CVC is known to be associated with vascular complications, it is standard practice to transfuse Fresh-Frozen Plasma or platelets to correct CCP. These CCP may not reflect true coagulopathy in liver disease. Additionally CVC when performed under ultrasound guidance (USG-CVC) in itself reduces the incidence of complications.
To assess the safety of USG-CVC and to evaluate the incidence of complications among liver disease patients with coagulopathy.
An audit of all USG-CVCs was performed among adult patients with liver disease in a tertiary care center.
Data was collected for all the adult patients (18-60 years) of either gender suffering from liver disease who had required USG-CVC. Univariate and multivariate regression analysis was done to identify possible risk factors for complications.
The mean age of the patients was 42.1 ± 11.6 years. Mean international normalized ratio was 2.17 ± 1.16 whereas median platelet count was 149.5 (range, 12-683) × 10(9)/L. No major vascular or non-vascular complications were recorded in our patients. Overall incidence of minor vascular complications was 18.6%, of which 13% had significant ooze, 10.3% had hematoma formation and 4.7% had both hematoma and ooze. Arterial puncture and multiple attempts were independent risk factors for superficial hematoma formation whereas low platelet count and presence of ascites were independent risk factors for significant oozing.
Ultrasound guidance -CVC in liver disease patients with deranged coagulation is a safe and highly successful modality.
在患有常规凝血参数（CCP）紊乱的肝病患者的治疗过程中，经常需要进行中心静脉置管（CVC）。由于已知CVC与血管并发症相关，因此输注新鲜冷冻血浆或血小板以纠正CCP是标准做法。这些CCP可能无法反映肝病中的真正凝血病。此外，在超声引导下进行CVC（USG-CVC）本身可降低并发症的发生率。
评估USG-CVC的安全性，并评估凝血病肝病患者的并发症发生率。
在一家三级护理中心对所有患有肝病的成年患者进行的USG-CVC审计。
收集所有需要USG-CVC的成年（18 - 60岁）肝病患者的数据。进行单因素和多因素回归分析以确定并发症的可能危险因素。
患者的平均年龄为42.1±11.6岁。平均国际标准化比值为2.17±1.16，而血小板计数中位数为149.5（范围12 - 683）×10⁹/L。我们的患者中未记录到重大血管或非血管并发症。轻微血管并发症的总体发生率为18.6%，其中13%有明显渗血，10.3%有血肿形成，4.7%既有血肿又有渗血。动脉穿刺和多次尝试是浅表血肿形成的独立危险因素，而低血小板计数和腹水的存在是明显渗血的独立危险因素。
对于凝血紊乱的肝病患者，超声引导下的CVC是一种安全且非常成功的方式。
