老年患者不同中心静脉置管方式血栓并发症比较

Comparison of incidence rate of catheter-related thrombosis in senile patients with different central venous catheterization positions

目的分析老年患者锁骨下静脉置管、股静脉置管、颈内静脉置管和经外周静脉置入中心静脉导管(peripherally inserted central catheter,PICC)置管时导管相关性血栓的发生率,为导管相关性血栓的预防提供指导。方法选取2008年1月-2012年12月在我院老年病房接受各类中心静脉置管的患者717例,对其一般情况、基础疾病、临床特点和导管相关性血栓发生情况进行分析。结果 717例中69例发生导管相关性血栓并发症(9.62%);锁骨下静脉组血栓发生率低于股静脉组和PICC组(3.27%vs 16.67%,P<0.01;3.27%vs 12.72%,P<0.01),略低于颈内静脉组(3.27%vs 10.81%,P<0.05),股静脉组、PICC组和颈内静脉组血栓发生率无统计学差异(P>0.05)。结论老年患者建议首选锁骨下静脉置管;PICC置管可用于某些特定疾病的患者,但要强化血栓预防措施。

Objective To investigate the incidence rate of catheter-related thrombosis in senile patients with 4 kinds of catheterization positions： subclavian vein, femoral vein, jugular vein and PICC, provide guidance for the prevention of catheter-related thrombosis. Methods Seven hundred and seventeen hospitalized senile patients with central venous catheterization in geriatric department of Chinese PLA General Hospital from January 2008 to December 2012 were selected. Retrospective investigation and analysis were carried out on general conditions, basic diseases, clinical characteristics and incidence of catheter-related thrombosis. Results Of the 717 patients, 69 cases（9.62%） were diagnosed with catheter-related thrombosis. The incidence rate of catheter-related thrombosis in subclavian vein group was lower than femoral vein group（3.27% vs 16.67%, P 0.01） and PICC group（3.27% vs 12.72%, P 0.01）, and it was also lower than jugular vein group（3.27% vs 10.81%, P〈 0.05）. No difference was found between femoral vein, PICC, and jugular vein group（P〈 0.05）. Conclusion Subclavian vein catheterization is the best choice for senile patients. PICC can be used in patients with specialized diseases, while some measures should be reinforced to prevent thrombosis.