非化疗患者中心静脉导管合并血栓的抗凝处理探讨

Discussion on anticoagulation treatment of central venous catheter with thrombosis in non-chemotherapy patients

目的研究依诺肝素钠及利伐沙班对防治中心静脉导管血栓及拔管安全的影响。方法选取我院接受中心静脉置管并发导管血栓形成的患者42例,使用依诺肝素钠抗凝治疗患者作为依诺肝素钠组(n=24),以利伐沙班抗凝患者作为利伐沙班组(n=18),连续抗凝5天,监测患者D二聚体变化,拔管前复查血管彩超明确血栓大小。结果经5天连续抗凝后,共40例患者D二聚体出现下降(95.2%),其中依诺肝素钠组23例,利伐沙班组17例;调整剂量继续抗凝5天后其余2例患者D二聚体亦出现下降(4.8%)。所有患者血管彩超检查血栓范围较抗凝前均未见明显增加。所有患者导管均顺利拔除,未发生影响生命体征的肺栓塞及出血并发症。结论依诺肝素钠及利伐沙班对导管血栓有抑制作用,导管血栓患者拔管前应用依诺肝素钠及利伐沙班抗凝治疗是安全和有效的。

Objective To study the effect of enoxaparin sodium and rivaroxaban on the prevention and treatment of central venous catheter thrombosis and safety of extubation.Methods Forty-two patients who received central venous catheterization and catheter thrombosis in our hospital were selected in this research.The patients treated with enoxaparin sodium anticoagulation therapy were included in the enoxaparin sodium group(n=24),and the patients with elivaroxaban anticoagulation were included in the rivaroxaban group(n=18),and the anti coagulation was performed for 5 consecutive days.The changes of dimer D in the patients were monitored,and the blood vessel color doppler ultrasound was used to determine the size of the thrombus before extubation.Results After continuous anticoagulation for 5 days,D dimer decreased in 40 patients(95.2%).There were 23 cases in enoxaparin sodium group and 17 cases in rivaroxaban group.After adjusting the anti coagulation dose,D dimer also decreased in the other 2 patients after 5 days of continued anti coagulation(4.8%).No significant increase in the thrombus range was observed in all patients compared with that before anti coagulation Catheters were removed successfully in all patients without complications of pulmonary embolism or hemorrhage affecting vital aigns.Conclusion Enoxaparin sodium and rivaroxaban have inhibitory effects on catheter thrombosis,and the application of enoxaparin sodium and rivaroxaban anticoagulation therapy before extubation in patients with catheter thrombosis is safe and effective.