神经重症患者锁骨下静脉置管血栓形成的相关因素分析

Related factors of thrombosis caused by subclavian vein catheterization in neurological intensive patients

目的探讨神经重症患者锁骨下静脉置管(SVC)引起导管相关性血栓(CRT)的相关因素。方法分析132例神经重症并SVC患者的临床资料及实验室检测指标,用Logistic回归模型进行相关因素分析。结果 132例患者中发生CRT者42例(31.82%)。CRT组与非CRT组患者间年龄、置管时间、反复在同一部位穿刺、脑梗死、使用刺激性药物、抗血小板药物的差异有统计学意义(均P<0.05)。CRT组患者的血小板计数、纤维蛋白原、D-二聚体、纤维蛋白降解产物明显高于非CRT组(均P<0.05)。多因素Logistic分析示年龄>60岁、置管时间>20 d、反复在同一部位穿刺、刺激性药物、高纤维蛋白原、高D-二聚体是神经重症并SVC患者发生CRT的独立危险因素(均P<0.05)。结论神经重症患者行SVC后机体处于高凝状态,发生导管相关性血栓风险增大,高龄、置管时间长、反复在同一部位穿刺、刺激性药物、高纤维蛋白原、高D-二聚体是导管相关性血栓形成的独立危险因素。

Objective To identify related risk factors of catheter related thrombosis（CRT） caused by subclavian vein catheterization（SVC） in neurological intensive patients. Methods The clinical data of 132 neurological intensive patients with SVC were analyzed. Logistic regression model was used for analysis of related factors of thrombosis. Results In 132 patients,42 cases（31. 82%） were suffered CRT. The age,catheterretaining time,repeated puncture at the same site,cerebral infarction,stimulant medications and anti-platelet drugs between the CRT group and the non-CRT group were significantly different（all P 〈 0. 05）. The number of platelet and the level of fibrinogen,D-Dimer and fibrin degradation products of CRT group were significantly higher than those in non-CRT group（all P 〈 0. 05）. Multivariate Logistic regression analysis showed that age 〉 60 years old,catheterretaining time 〉 20 d,repeated puncture at the same site,stimulant medications,high fibrinogen,high D-Dimer were independently risk factors of CRT caused by SVC in neurological intensive patients（all P 〈 0. 05）. Conclusions After SVC,neurological intensive patient is in a hypercoagulable state,the incidence of CRT is increased. Old age,long catheter-retaining time,repeated puncture at the same site,stimulant medications,high fibrinogen,high DDimer are independent risk factors of catheter related thrombosis.