Luo Yueqin, Zhou Ming, Wang Bolei
Department of Critical Medicine, Beihai People's Hospital, Beihai 536000, Guangxi Zhuang Autonomous Region, China.
Department of Emergency, Beihai People's Hospital, Beihai 536000, Guangxi Zhuang Autonomous Region, China. Corresponding author: Luo Yueqin, Email:
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2020 Aug;32(8):994-997. doi: 10.3760/cma.j.cn121430-20200416-00302.
To investigate the effect of thromboelastography (TEG) combined with point-of-care ultrasound (POCUS) guidance on the prevention of internal jugular vein catheterization related thrombosis.
The patients who required internal jugular vein catheterization admitted to the department of critical medicine of Beihai People's Hospital from December 2018 to April 2020 were enrolled. Patients were divided into two groups according to the random number table method. For the combined cathetherization group, ultrasound was used to examine bilateral internal jugular veins before catheterization. The larger diameter and better filled vein and site were selected for puncture. If both internal jugular veins were not fulfilled well, puncture were performed after fluid administration. At the same time, anticoagulant, antiplatelet or reducing blood viscosity drugs were used according to coagulation function and bleeding risk under the monitoring of TEG. The hemodynamic state of the internal jugular vein was monitored by ultrasound every day. If the vein collapsed or the blood flow was slow, the cause should be tried to be found and improved. Once thrombosis was found, the catheter should be removed. For the routine cathetherization group, the right side internal jugular vein was prior to be punctured according to body surface symbols. The other treatment of the two groups were the same as routine treatment. The conditions of thrombosis and bleeding were recorded.
Ninety-seven patients were selected, 51 cases in the combined cathetherization group and 46 cases in the routine cathetherization group. There was no significant differences in gender, age, acute physiology and chronic health evaluation II (APACHE II), risk of deep vein thrombosis score (Caprini), CRUSADE bleeding risk score, the proportion of high bleeding risk, disease types, the proportion of coagulation disorder and catheterization time between the two groups, but the anticoagulation treatment proportion in the combined cathetherization group was higher than that in the routine cathetherization group (66.7% vs. 30.4%, P < 0.01). The incidence of thrombosis in the combined cathetherization group was lower than that of the routine cathetherization group (39.2% vs. 78.3%, P < 0.01), and the thrombus of the combined cathetherization group was smaller than that of the routine cathetherization group [cm: 0.077 (0.047, 0.089) vs. 0.341 (0.070, 0.378), P < 0.01]. There were no major bleeding events in the two groups.
Based on TEG and POCUS, the antithrombotic bundles can reduce the incidence of thrombosis after internal jugular vein catheterization and the thrombus size, and does not increase the risk of bleeding, which is worthy of clinical application.
探讨血栓弹力图（TEG）联合床旁超声（POCUS）引导对预防颈内静脉置管相关血栓形成的效果。
选取2018年12月至2020年4月在北海市人民医院重症医学科需行颈内静脉置管的患者。根据随机数字表法将患者分为两组。联合置管组在置管前用超声检查双侧颈内静脉。选择直径较大、充盈良好的静脉及部位进行穿刺。若双侧颈内静脉均充盈不佳，则在补液后进行穿刺。同时，在TEG监测下根据凝血功能及出血风险使用抗凝、抗血小板或降低血液黏稠度的药物。每天用超声监测颈内静脉的血流动力学状态。若静脉塌陷或血流缓慢，应查找原因并予以改善。一旦发现血栓，应拔除导管。常规置管组根据体表标志优先穿刺右侧颈内静脉。两组的其他治疗同常规治疗。记录血栓形成及出血情况。
共入选97例患者，联合置管组51例，常规置管组46例。两组患者在性别、年龄、急性生理与慢性健康状况评分系统II（APACHE II）、深静脉血栓形成风险评分（Caprini）、CRUSADE出血风险评分、高出血风险比例、疾病类型、凝血障碍比例及置管时间方面比较，差异均无统计学意义，但联合置管组的抗凝治疗比例高于常规置管组（66.7%比30.4%，P<0.01）。联合置管组血栓形成发生率低于常规置管组（39.2%比78.3%，P<0.01），且联合置管组的血栓小于常规置管组[厘米：0.077（0.047，0.089）比0.341（0.070，0.378），P<0.01]。两组均未发生大出血事件。
基于TEG和POCUS的抗栓方案可降低颈内静脉置管后血栓形成的发生率及血栓大小，且不增加出血风险，值得临床应用。
