Wanscher M, Frifelt J J, Smith-Sivertsen C, Andersen A P, Rasmussen A D, Sanchez Garcia R, Køhler F
Department of Anesthesia, Odense University Hospital, Denmark.
Crit Care Med. 1988 Jun;16(6):624-8. doi: 10.1097/00003246-198806000-00013.
During an 18-month period, 82 consecutive patients (37 women and 45 men), with a mean age of 50 yr (range 15 to 74), underwent hemodialysis with 91 polyurethane double-lumen subclavian superior vena cava catheters inserted via the right subclavian vein. Upon catheter removal, venograms were performed in 53 which revealed thrombosis in 13. Autopsy performed in 13 other patients revealed thrombosis in three. Mean catheter duration was 27 days (range 1 to 138). Catheter duration was significantly (p less than .01) longer in the 16 cases complicated by thrombosis. There was no significant difference in the frequency of thrombosis between men and women. Two patients developed symptoms of subclavian vein occlusion after the creation of an arteriovenous fistula on the same side as a previous hemodialysis catheter. Overall, thrombosis was found in 23% and increased with longer catheter duration. We recommend phlebography to exclude thrombosis before creating an arteriovenous fistula on the same side as the previous hemodialysis catheter. There was no case of clinical discernible pulmonary embolism.
在18个月期间，82例连续患者（37例女性和45例男性），平均年龄50岁（范围15至74岁），通过右锁骨下静脉插入91根聚氨酯双腔锁骨下上腔静脉导管进行血液透析。拔除导管后，对53例患者进行了静脉造影，其中13例显示有血栓形成。对另外13例患者进行的尸检发现3例有血栓形成。导管平均使用时间为27天（范围1至138天）。在16例并发血栓形成的病例中，导管使用时间明显更长（p小于0.01）。男性和女性之间血栓形成的频率没有显著差异。2例患者在与先前血液透析导管同侧建立动静脉内瘘后出现锁骨下静脉闭塞症状。总体而言，血栓形成发生率为23%，且随着导管使用时间延长而增加。我们建议在与先前血液透析导管同侧建立动静脉内瘘之前进行静脉造影以排除血栓形成。没有临床可察觉的肺栓塞病例。
