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| 抗生素涂层中心静脉置管对导管相关深静脉血栓的影响 |
| Effect of anti-microbial-coated central venous catheter on catheter-associated deep venous thrombosis |
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| DOI：10.12089/jca.2018.04.005 |
| 中文关键词: 抗生素涂层 中心静脉导管 导管相关深静脉血栓 |
| 英文关键词: Anti-microbial Central venous catheter Catheter-associated deep venous thrombosis |
| 基金项目:福州总医院院立课题临床研究专项(2015L05) |
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| 中文摘要: |
| 目的 评价和比较抗生素涂层与普通中心静脉置管对导管相关深静脉血栓(catheter-associated deep venous thrombosis, CADVT)的影响。方法 回顾分析2017年1～6月行颈内静脉、腋-锁骨下静脉或股静脉穿刺置管的择期手术患者1 359例,年龄26～82岁,ASA Ⅰ～Ⅲ级。采用倾向性评分法按1∶1匹配分为两组,即抗生素涂层中心静脉置管组(A组)和普通中心静脉置管组(B组)。匹配因素包括性别、年龄、ASA分级、术前血栓风险(Caprini评分)、中心静脉置管部位、手术部位、是否采用超声引导穿刺置管、是否接受抗凝治疗等。分析术后CADVT的风险和血栓程度,以及置管相关并发症。结果 共938例患者匹配成功,共323例患者(34.4％)经床旁超声诊断为CADVT,其中A组172例(36.7％),B组151例(32.2％),两组CADVT发生率和血栓程度差异无统计学意义;亚组分析结果表明,高危血栓风险(Caprini评分≥5分)(OR 1.34, 95％CI 1.01～1.78)、体表标志定位穿刺置管(OR 1.69, 95％CI 1.04～2.74)和未接受抗凝治疗(OR 1.39, 95％CI 1.01～1.92)的患者使用抗生素涂层中心静脉导管CADVT的风险高于普通中心静脉导管;A组患者导管相关感染发生率明显低于B组(0.9％ vs 4.1％, P＜ 0.05);其余置管相关并发症发生率差异均无统计学意义。结论 抗生素涂层中心静脉置管不增加CADVT的发生率。 |
| 英文摘要: |
| Objective To evaluate the effect of anti-microbial-coated central venous catheter (CVC), compared with routine CVC, on catheter-associated deep venous thrombosis (CADVT). Methods A total of 1 359 patients, aged 26-82 years, ASA physical status Ⅰ-Ⅲ, undergoing internal jugular, axillary-subclavian, or femoral vein CVC catheterization during January to June of 2017, were retrospectively reviewed. The patients were divided into intoanti-microbial-coated CVC group (group A) and routine CVC group (group B). Gender, age, ASA class, pre-operative risk of thrombus (Caprini score), CVC site, surgical site, ultrasound-guided catheterization, and anticoagulation therapy, CADVT and the degree, as well as the other adverse events were recorded. Results A total of 938 patients were successfully matched. There were 323 (34.4％) articipants diagnosed with CADVT with bedside point-of-care ultrasound, in which 172 cases (36.7％) in group A and 151 (32.2％) in group B. There was no statistical significance of CADVT and the degree between the two groups. The subgroup analysis results indicated that the patients using anti-microbial-coated CVC with high risk of thrombus (Caprini score ≥ 5 points) (OR 1.34, 95％CI 1.01-1.78), undergoing catheterization according to anatomical landmark (OR 1.69, 95％CI 1.04-2.74), and not-receiving anticoagulation therapy (OR 1.39, 95％CI 1.01-1.92) had an increased risk of CADVT compared with those using routine CVC. A significantly decreased incidence of catheter-associated infection in group A was observed compared with group B (0.9％ vs 4.1％, P＜0.05). Conclusion Anti-microbial-coated CVC does not increase the incidence of CADVT. |
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