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评估体外循环下心血管手术中经皮右颈内静脉插入上腔静脉导管后的血栓形成。

Assessment of thrombosis in right internal jugular vein after percutaneous superior vena cava catheter insertion during cardiovascular surgery with cardiopulmonary bypass.

机构信息

Department of Anesthesiology and Pain Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea.

Department of Anesthesiology and Pain Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea; Research Institute of Medical Science, Konkuk University School of Medicine, Seoul, Korea.

出版信息

J Thorac Cardiovasc Surg. 2016 Dec;152(6):1592-1599. doi: 10.1016/j.jtcvs.2016.07.071. Epub 2016 Aug 28.

Abstract

OBJECTIVE

We evaluated the incidence of percutaneous superior vena cava catheter-related thrombosis and identified risk factors for developing the condition in patients undergoing cardiovascular surgery with cardiopulmonary bypass.

METHODS

A total of 121 patients were evaluated. A percutaneous superior vena cava catheter was inserted into the right internal jugular vein during cardiovascular surgery with cardiopulmonary bypass. The right internal jugular vein was evaluated using ultrasonography, including cross-sectional area and velocity just before insertion of the percutaneous superior vena cava catheter (preoperative) and 24 hours and 48 hours after its insertion. If an echogenic mass was detected in the right internal jugular vein, the size was measured.

RESULTS

The incidence of thrombosis in the right internal jugular vein was 56.2%. Change in the right internal jugular vein cross-sectional area and velocity had no clinical implications. Multiple logistic regression analysis identified age (odds ratio, 1.061; 95% confidence interval, 1.022-1.101; P = .002), superior vena cava catheter indwelling duration (odds ratio, 1.015; 95% confidence interval, 1.008-1.023; P < .001), and amount of transfusion platelet concentrate (odds ratio, 1.155; 95% confidence interval, 1.030-1.295; P = .013) as risk factors for percutaneous superior vena cava catheter-related thrombosis in the right internal jugular vein.

CONCLUSIONS

The incidence of percutaneous superior vena cava catheter-related thrombosis was higher than conventional central venous catheter-related thrombosis. Risk factors were age, superior vena cava catheter indwelling duration, and amount of transfusion platelet concentrate.

摘要

目的

我们评估了行体外循环心血管手术患者经皮上腔静脉导管相关血栓形成的发生率,并确定了发生该疾病的相关危险因素。

方法

共评估了 121 例患者。在体外循环心血管手术中,经皮上腔静脉导管插入右侧颈内静脉。在插入经皮上腔静脉导管前(术前)、插入后 24 小时和 48 小时,使用超声心动图评估右侧颈内静脉,包括其横截面积和血流速度。如果在右侧颈内静脉中检测到回声团块,则测量其大小。

结果

右侧颈内静脉血栓形成的发生率为 56.2%。右侧颈内静脉横截面积和血流速度的变化无临床意义。多因素逻辑回归分析确定年龄(比值比,1.061;95%置信区间,1.022-1.101;P=0.002)、上腔静脉导管留置时间(比值比,1.015;95%置信区间,1.008-1.023;P<0.001)和输注血小板浓缩物的量(比值比,1.155;95%置信区间,1.030-1.295;P=0.013)是右侧颈内静脉经皮上腔静脉导管相关血栓形成的危险因素。

结论

经皮上腔静脉导管相关血栓形成的发生率高于传统中心静脉导管相关血栓形成。危险因素是年龄、上腔静脉导管留置时间和输注血小板浓缩物的量。

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