Ju Jae-Woo, Oh Yoomin, Yang Hyo Jun, Lee Seohee, Bae Jinyoung, Nam Karam, Cho Youn Joung, Jeon Yunseok, Kim Tae Kyong
Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 03080, Korea.
Department of Anesthesiology and Pain Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul 07061, Korea.
J Clin Med. 2021 Mar 3;10(5):1042. doi: 10.3390/jcm10051042.
Lower right internal jugular vein (RIJ) stenosis has been reported as a common cause of RIJ catheterization failure. However, the risk factors for lower RIJ stenosis in patients undergoing cardiac surgery is unclear. We reviewed the electronic medical records of all adult patients who had undergone cardiac operations in a single tertiary university hospital from January 2014 to January 2016. Patients were excluded if they were lack of preoperative contrast-enhanced chest computed tomography (CT) studies. Lower RIJ stenosis was defined as a ratio of cross-sectional area at the smallest level to cross-sectional area at the largest level less than 25%. Multivariable logistic regression analyses were used to investigate the risk factors for lower RIJ stenosis. A sensitivity analysis was also conducted using a cross-sectional area ratio of under 20%. The analysis included 889 patients, and the incidence of lower RIJ stenosis was 3.9%. The multivariable logistic regression analyses revealed that hemodialysis was an independent risk factor for lower RIJ stenosis (OR, 3.54; 95% CI, 1.472-8.514). Sensitivity analysis provided that hemodialysis (OR, 10.842; 95% CI, 3.589-32.75) was a significant predictor of cross-sectional area ratio <20%. Preoperative hemodialysis are significantly associated with an increased risk of lower RIJ stenosis in patients undergoing cardiac surgery. Extra care is needed during central venous catheterization in hemodialysis patients undergoing cardiac surgery.
右下颈内静脉（RIJ）狭窄已被报道为RIJ置管失败的常见原因。然而，心脏手术患者右下RIJ狭窄的危险因素尚不清楚。我们回顾了2014年1月至2016年1月在一家单一的三级大学医院接受心脏手术的所有成年患者的电子病历。如果患者缺乏术前胸部增强计算机断层扫描（CT）研究，则将其排除。右下RIJ狭窄定义为最小水平的横截面积与最大水平的横截面积之比小于25%。采用多变量逻辑回归分析来研究右下RIJ狭窄的危险因素。还使用20%以下的横截面积比进行了敏感性分析。该分析纳入了889例患者，右下RIJ狭窄的发生率为3.9%。多变量逻辑回归分析显示，血液透析是右下RIJ狭窄的独立危险因素（OR，3.54；95%CI，1.472 - 8.514）。敏感性分析表明，血液透析（OR，10.842；95%CI，3.589 - 32.75）是横截面积比<20%的显著预测因素。术前血液透析与心脏手术患者右下RIJ狭窄风险增加显著相关。在接受心脏手术的血液透析患者进行中心静脉置管时需要格外小心。
