血透患者右无名静脉损伤后超长时活动性出血一例

Prolonged active hemorrhage after right innominate vein injury patient with hemodialysis: a case report

血液透析中心静脉导管插管导致静脉损伤继发局部血肿是常见并发症,但围插管期无症状、插管后数月出现气管压迫、危及生命的活动性出血少见。该文报道一例45岁男性患者,因右侧颈内静脉置管后4个月出现右侧无名静脉严重活动性出血、纵隔血肿压迫气管,经过控制血压、减少容量负荷、关闭同侧内瘘后出血停止、最后血肿吸收。该例提示应重视深静脉置管穿刺损伤引发纵隔血肿的可能性,尤其在穿刺不顺利时应当立即行胸片、CT或超声检查,以减少漏诊和误诊。

Local hematoma is a common complication secondary to central venous catheter intubation during hemodialysis. However, it is rare to have asymptomatic peri-intubation, tracheal compression and lifethreatening active bleeding occur at several months after catheterization.This paper reports a 45-year-old male patient with severe active bleeding of right innominate vein and mediastinal hematoma compressing trachea 4 months after right internal jugular vein catheterization. After controlling blood pressure, reducing volume load, closing ipsilateral autogenous arteriovenous fistula, bleeding stopped and hematoma absorbed finally.This case suggests that extensive attention should be paid to the possibility of mediastinal hematoma caused by deep vein catheterization injury. Especially if the puncture is not successful, chest X-ray, CT scan or ultrasound examination should be performed immediately to reduce the risk of missing diagnosis and misdiagnosis.