Department of Cardiovascular & Thoracic Surgery, University of Texas MD Anderson Cancer Center, Houston, TX, United States.
Department of Cardiovascular & Thoracic Surgery, University of Texas MD Anderson Cancer Center, Houston, TX, United States; Department of Interventional Radiology, University of Texas MD Anderson Cancer Center, Houston, TX, United States.
Am J Surg. 2019 Jan;217(1):133-137. doi: 10.1016/j.amjsurg.2018.06.019. Epub 2018 Jun 27.
We sought to assess the incidence and risk factors of bleeding after ultrasound-guided internal jugular (USGIJ) catheter insertion in severely thrombocytopenic cancer patients, as safe platelet (PLT) count threshold remains controversial.
Retrospective study of 52 patients with hematologic malignancies and severe thrombocytopenia who underwent USGIJ catheter insertion between 2014 and 2016. Group A included patients with prophylactic PLT transfusion and Group B without. Statistical analysis was performed.
Group A included 28 patients and Group B 24. Baseline characteristics were equally distributed. Median catheter size was 12 Fr and tunneled in 20/52 patients. Median PLT count was not statistically different between the groups, before transfusion and after the procedure. Postoperative minor bleeding occurred in 10/52 patients, similar between groups. Lower PLT count, larger catheter caliber and trend for AML diagnosis were identified as risk factors for bleeding. Age, gender, BMI, renal dysfunction and tunneled insertion were not significant.
Incidence of minor bleeding is low in severely thrombocytopenic patients after USGIJ catheter insertion. Prophylactic platelet transfusion may be reserved for patients with identified risk factors.
我们旨在评估在严重血小板减少症癌症患者中进行超声引导下颈内静脉（USGIJ）导管插入后的出血发生率和风险因素，因为安全的血小板（PLT）计数阈值仍存在争议。
回顾性研究了 2014 年至 2016 年间接受 USGIJ 导管插入术的 52 例血液恶性肿瘤和严重血小板减少症患者。A 组包括预防性 PLT 输注患者，B 组无 PLT 输注患者。进行了统计分析。
A 组包括 28 例患者，B 组包括 24 例患者。基线特征分布均匀。中位导管大小为 12Fr，20/52 例患者行隧道式插入。在输血前和手术后，两组的 PLT 计数中位数无统计学差异。52 例患者中有 10 例发生轻微术后出血，两组之间相似。较低的 PLT 计数、较大的导管口径和 AML 诊断趋势被确定为出血的危险因素。年龄、性别、BMI、肾功能和隧道式插入不是显著因素。
在严重血小板减少症患者中，USGIJ 导管插入后发生轻微出血的发生率较低。对于有明确危险因素的患者，可以保留预防性血小板输注。
