胸外科术后与导管相关的右颈内静脉血栓形成
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Catheter-related right internal jugular vein thrombosis after chest surgery
背景与目的
中心静脉导管（CVC）经常用于监测血液动力学，并在围术期和术后进行快速补液治疗。通常在术后7-14天留置CVC继续进行监测和治疗，但患者可能会出现无症状的与导管相关的血栓形成，可导致危及生命的肺栓塞和死亡。早期检测有助于避免这种并发症。
方 法
这项前瞻性观察性研究调查了胸外科手术患者与导管相关的右颈内静脉血栓形成相关的危险因素。该研究纳入了24名计划接受胸外科手术且需要置入中心静脉导管的患者。为了检测血栓形成，在CVC放置后和在伺候每一天在甲状软骨水平到锁骨上区域进行多普勒超声检查，直到导管被移除。
结 果
手术前患者无血栓形成，手术后的发生率为75％（18/24）。血栓形成的风险随着麻醉时间的延长、出血量的增加和术后呼吸机的使用而增加。
结 论
早期移除导管可能会降低导管相关血栓形成的风险，并避免导管相关血栓形成后可致命的并发症。
原始文献摘要
Chen PT,Chang KC, Hu KL, Ting CK, Chan KH, Chang WK1,.Catheter-related right internal jugular vein thrombosis after chest surgery.Br J Anaesth. 2017 Jun 26.
Background: Central venous catheters (CVCs) are frequently used for monitoring haemodynamic status and rapidly delivering fluid therapy during the peri- and postoperative periods. Indwelling CVCs are typically used 7–14 days postoperatively for additional monitoring and treatment, but patients may develop asymptomatic catheter-related thrombosis, leading to life-threatening pulmonary embolism and death. Early detection helps to avoid such complications.
Methods: This prospective observational study investigated the risk factors associated with catheter-related right internal jugular vein thrombosis in patients undergoing chest surgery. The study enrolled 24 patients who were scheduled to receive chest surgeries during which catheters were needed. To detect thrombus formation, Doppler ultrasound examinations from the thyroid cartilage level to the supraclavicular region were used after CVC placement and on each of the following days until the catheter was removed.
Results: No thrombosis was found in patients before surgery, but it appeared in 75% (18/24) after surgery. The risks of thrombosis increased with a longer duration of anaesthesia, greater amounts of bleeding, and use of postoperative ventilator support.
Conclusions: Earlier catheter removal may reduce the risk of catheter-related thrombosis and avoid possibly fatal complications after catheter-related thrombosis.
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