Barrera R, Mina B, Huang Y, Groeger J S
Department of Anesthesiology and Critical Care Medicine, Memorial Sloan-Kettering Cancer Center Cornell University Medical College, New York, New York 10021, USA.
Cancer. 1996 Nov 1;78(9):2025-30.
Morbidities associated with the insertion of central venous catheters in severely thrombocytopenic cancer patients were analyzed in this prospective observational study. One hundred fifteen consecutive thrombocytopenic patients requiring central venous access (internal jugular or subclavian vein cannulation by a modified Seldinger technique) were evaluated.
One hundred fifteen catheters were inserted. For each patient, the following factors were documented: age; sex; diagnosis; previous catheterization; prior neck, chest, breast, or axillary surgery or radiation therapy; presence of other lines prior to venipuncture; site and indication for line insertion; complications; PT and PTT; platelet counts; and hematocrit.
Of the total number of catheters inserted, 63 (55%) were subclavian and 52 (45%) were internal jugular. Successful cannulations with no complications (n = 91; 79% of the total) were achieved with 1.2 +/- 0.5 attempts. Twenty-four major and minor complications (20%) occurred with an average of 1.6 +/- 1 attempts (P = 0.003). The mean preprocedure platelet counts were 14.8 +/- 4.5 x 10(9)/L for the subclavian group and 14.3 +/- 4.8 x 10(9)/L for the internal jugular group. With platelet transfusion, the mean postprocedure platelet counts for the subclavian and internal jugular groups were 23.9 +/- 12.8 x 10(9)/L and 24.6 +/- 15 x 10(9)/L, respectively. In the subclavian group, seven patients (6%) experienced minor complications. There were 17 minor complications (15%) and 1 pneumothorax in the internal jugular group. Patients experiencing more than one attempt at cannulation had more complications (P = 0.003).
With the appropriate precautions and platelet transfusions, central venous catheters can be inserted safely with minimal complications into thrombocytopenic cancer patients. Fewer attempts are associated with fewer complications. High risk procedures should be attempted only by experienced personnel or under their direct and strict supervision.
在这项前瞻性观察研究中，分析了严重血小板减少的癌症患者插入中心静脉导管相关的发病率。对115例连续需要中心静脉通路（采用改良Seldinger技术进行颈内静脉或锁骨下静脉插管）的血小板减少患者进行了评估。
插入了115根导管。记录了每位患者的以下因素：年龄；性别；诊断；既往插管情况；既往颈部、胸部、乳腺或腋窝手术或放疗史；静脉穿刺前其他管路的存在情况；管路插入部位及指征；并发症；PT和PTT；血小板计数；以及血细胞比容。
在插入的导管总数中，63根（55%）为锁骨下静脉导管，52根（45%）为颈内静脉导管。平均1.2±0.5次尝试实现了91次（占总数的79%）无并发症的成功插管。发生了24例主要和次要并发症（20%），平均尝试次数为1.6±1次（P = 0.003）。锁骨下静脉组术前平均血小板计数为14.8±4.5×10⁹/L，颈内静脉组为14.3±4.8×10⁹/L。经血小板输注后，锁骨下静脉组和颈内静脉组术后平均血小板计数分别为23.9±12.8×10⁹/L和24.6±15×10⁹/L。在锁骨下静脉组，7例患者（6%）出现轻微并发症。颈内静脉组有17例轻微并发症（15%）和1例气胸。插管尝试次数超过一次的患者并发症更多（P = 0.003）。
采取适当的预防措施并进行血小板输注，中心静脉导管可安全地插入血小板减少的癌症患者体内，并发症最少。尝试次数越少，并发症越少。高风险操作仅应由经验丰富的人员或在其直接严格监督下进行。
