di Costanzo J, Sastre B, Choux R, Kasparian M
Clinique de la Résidence du Parc, Marseilles, France.
JPEN J Parenter Enteral Nutr. 1988 Mar-Apr;12(2):190-4. doi: 10.1177/0148607188012002190.
Catheter material is considered as one of the main factors of deep venous thrombosis during parenteral nutrition. The effects of five types of catheters (polyethylene, polyurethane, silicone, TFE Teflon, and FEP Teflon) on the vein wall and on the blood flow were compared. Experiments were performed on rabbits in which catheters were inserted into the vena cava. Five series of experiments were performed, each including five animals with the same type of catheter. After 10 days, venograms of the vena cava were performed, animals were then killed and the vena cava was removed with the catheter in situ. The vein and the catheter were macroscopically examined; in cases with thrombosis the clot was weighed. The vein wall and the catheter were examined by conventional microscopy and by electron microscopy, respectively. Obstruction of the venous lumen were significantly more frequent with the rigid catheters than with the soft catheters (p less than 0.001). The most extensive thromboses occurred with the Teflon catheters. The incidence of fibrin sleeves was significantly higher with the soft catheters than with the rigid ones (p less than 0.01). The venographic and macroscopic findings were in agreement in 60-100% of the cases according to the degree of venous obstruction. Catheter surfaces remained unchanged in all cases. The polyethylene catheters induced the most severe intimal inflammatory reactions. Thrombus formation was caused by two mechanisms depending on catheter composition: (1) turbulence caused by the catheter in the blood stream, and (2) platelet aggregation and subsequently, fibrin deposition on the surface of the catheter.
导管材料被认为是肠外营养期间深静脉血栓形成的主要因素之一。比较了五种类型的导管（聚乙烯、聚氨酯、硅胶、TFE特氟龙和FEP特氟龙）对静脉壁和血流的影响。在将导管插入腔静脉的兔子身上进行了实验。进行了五组实验，每组包括五只使用相同类型导管的动物。10天后，对腔静脉进行静脉造影，然后处死动物，并将腔静脉与原位导管一起取出。对静脉和导管进行宏观检查；对于有血栓形成的病例，称取血栓重量。分别通过传统显微镜和电子显微镜检查静脉壁和导管。刚性导管导致静脉腔阻塞的频率明显高于柔性导管（p<0.001）。特氟龙导管发生的血栓最广泛。柔性导管的纤维蛋白套发生率明显高于刚性导管（p<0.01）。根据静脉阻塞程度，静脉造影和宏观检查结果在60%-100%的病例中一致。所有病例中导管表面均未发生变化。聚乙烯导管引起的内膜炎症反应最严重。血栓形成由两种机制引起，这取决于导管的成分：（1）导管在血流中引起的湍流，以及（2）血小板聚集，随后纤维蛋白沉积在导管表面。
