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腹部手术患者导管相关性右颈内静脉血栓的危险因素分析

Analysis of risk factors associated central venous catheter-related thrombosis in patients undergoing abdominal operation

摘要:

目的 分析腹部手术患者导管相关性右颈内静脉血栓的危险因素.方法 选取苏州大学附属第一医院行腹部手术且右颈内静脉置管的患者125例,年龄18~90岁,美国麻醉医师协会(ASA)分级Ⅰ~Ⅲ级.根据最终是否形成导管相关性血栓将患者分为无血栓组和血栓组.所有患者都在手术开始前行彩色多普勒超声引导下右颈内静脉穿刺置管,并在术后每天进行彩色多普勒超声监测直至拔除右颈内静脉导管,同时记录患者的年龄、性别、体质指数、术前Caprini评分、术中出血量、手术时间、麻醉时间,并在术后第3天检测所有患者D-二聚体水平.结果 术后出现导管相关性右颈内静脉血栓的发生率为12.8%(16/125).血栓组16例,男9例,女7例,平均年龄(73±7)岁,体质指数(22.8±2.9) kg/m2,术前Caprini评分为(6.1±1.4)分;无血栓组109例,男72例,女37例,平均年龄(66±11)岁,体质指数(22.6±2.9)kg/m2,术前Caprini评分为(5.9±1.3)分.两组患者在年龄、性别比、体质指数、术前Caprini评分方面差异均无统计学意义(均P>0.05).血栓组手术时间、麻醉时间、出血量以及术后第3天D-二聚体水平分别为(189±46) min、(21 1±59)min、(288±96)ml、(3.4±1.6)mg/L,无血栓组则分别为(139±39)min、(171±46)min、(175±114)ml、(2.0±0.9)mg/L,其中手术时间、出血量以及术后第3天D-二聚体水平差异均有统计学意义(U=10.768、359.000、390.000,均P<0.05),麻醉时间差异无统计学意义(P>0.05).手术时间、出血量及术后第3天D-二聚体水平是导管相关性血栓形成的独立危险因素(OR=10.037、1.011、3.274,均P<0.05).结论 腹部手术患者导管相关性右颈内静脉血栓的发生率高,与患者的手术时间、出血量、术后第3天D-二聚体水平等因素密切相关.

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abstracts:

Objective To analyze the risk factors of catheter-related right jugular venous thrombosis in patients undergoing abdominal surgery.Methods A total of 125 patients (18-90 years,ASA Ⅰ-Ⅲ) scheduled for abdominal surgery underwent right internal jugular in our study.Ultrasound-guided central venous catheterization were carried out before surgery and Doppler ultrasound examination were conducted daily postoperatively until the catheter was removed.The patients were divided into thrombosis positive or negative group based on the Doppler ultrasound examinations.General clinical data of all patients including name,gender,age,BMI,preoperative Caprini score,bleeding,duration of operation and anesthesia,were also collected.D-dimer test was performed on the third postoperative day.Results Of the 125 patients,16(12.8%) were found to have catheter-related right internal jugular vein thrombosis.There were 16 cases (9 males and 7 females) in the thrombosis positive group,with an average age of (73±7) years old,body mass index (22.8±2.9) kg/m2,and preoperative Caprini score (6.1 ± 1.4).In the thrombosis negative group,among whom 72 were men and 37 were women.The average age of these patients was (66±11) years old,BMI was (22.6±2.9)kg/m2,and preoperative Caprini score was (5.9± 1.3).There was no statistical difference between the two groups regarding age,gender,BMI,preoperative Caprini score(P>0.05).The average operating time,anesthesia time,bleeding amount and D-dimer level on the third postoperative day were (189 ±46) min,(211 ± 59) min,(288± 96) ml,(3.4± 1.6) mg/L in thethrombosis positive group,and (139 ± 39) min,(171 ±46) min,(175± 114) ml,(2.0±0.9) mg/L in the thrombosis negative group,respectively.Duration of surgery,bleeding amount and D-dimer level on the third postoperative day significantly affected the occurrence of catheter-related right internal jugular venous thrombosis (U=10.768,359.000,390.000,P<0.05),but no statistically significant differences in anesthesia time between the two groups.Logistic regression analysis screened out duration of surgery,bleeding amount and D-dimer level on the third postoperative day as risk factors for catheter-related right jugular venous thrombosis(OR=10.037,1.011,3.274,P<0.05).Conclusion The high incidence of catheter-related right jugular venous thrombosis in patients undergoing abdominal surgery is closely related to intraoperative blood loss,operation time,D-dimer level on the third postoperative day and other factors.

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