【摘要】 目的  探討經腋靜脈穿刺中央靜脈置管后上肢深靜脈血栓形成情況。 方法  2007年1月-2009年12月共收治60例需行中央靜脈置管的患者，所有患者均通過腋靜脈穿刺行中央靜脈插管，并于拔除導管后行彩色多普勒超聲檢查了解雙側上肢深靜脈血栓形成情況。將腋靜脈穿刺側上肢作為穿刺組，對側上肢作為對照組，進行前瞻性對照研究，將兩組上肢深靜脈血栓發生率進行比較。 結果  60例患者中央靜脈置管平均時間為（14.7±7.4） d，對照組彩色多普勒超聲檢查無深靜脈血栓形成，穿刺組2例患者出現上肢深靜脈血栓形成的癥狀，無肺栓塞發生，28例患者（47%）拔除的導管周圍可見纖維蛋白套形成，經上肢彩色多普勒超聲檢查，5例患者（8.3%）腋靜脈不完全栓塞，2例患者（3.3%）腋靜脈完全栓塞。在中央靜脈置管時間≤6 d的患者中，無上肢深靜脈血栓形成；置管時間在7~14 d的患者中，2例（3.3%）腋靜脈血栓形成；5例（8.3%）腋靜脈血栓形成發生在置管時間≥15 d（P lt;0.01）。7例腋靜脈血栓形成患者，經2~3次穿刺成功，平均穿刺時間（10±2.5） min，與無腋靜脈血栓形成患者的平均穿刺所需時間（14±9）min比較，無統計學意義（P gt;0.05）。 結論  經腋靜脈穿刺中央靜脈置管后上肢深靜脈血栓形成的發生率為11.6%。
【Abstract】 Objective  To determine the frequency of central venous catheter-induced thrombosis of the axillary vein. Methods  Sixty patients in a medical-surgical intensive care unit who required central venous catheterization via the axillary vein from January 2007 to December 2009 were selected. On catheter removal, color doppler ultrasonography examination was performed on all the patient. The incidence of deep vein thrombosis in catheterized arms was compared with that in uncatheterized arms. This study was designed by prospective controlled study. Results  Catheters were inserted for a mean duration of (14.7±7.4) days. Sixty patients who underwent axillary vein cannulation, one patient had clinical signs of arm vein thrombosis, and no patient had clinical sign of pulmonary embolism. Fibrin sleeves that developed around the catheters were observed in 28 patients (47%). Five patients (8.3%) had phlebographic signs of partial axillary vein thrombosis:nonobstructive clots adherent to the vessel wall and (or) the catheter. Two patients (3.3%) had color doppler ultrasonography signs of complete axillary vein thrombosis. No thrombosis was observed in patients with catheterizations lasting ≤6 days, two cases were observed for duration of 7-14 days, and five cases were observed for duration of ≥15 days (P lt;0.01). In seven patients with axillary vein thrombosis, the vessel was cannulated with fewer than three puncture attempts, and the mean duration for catheter insertion (10±2.5) minutes didn’t differ much from that of patients with no axillary vein thrombosis (14±9) minutes. Conclusion  The axillary vein catheterization is associated with 11.6% frequency of upper-extremity deep vein thrombosis.

引用本文： 杜蓉,周晏林. 經腋靜脈穿刺中央靜脈置管后上肢深靜脈血栓形成的臨床觀察. 華西醫學, 2010, 25(10): 1888-1890. doi: 復制