经腋静脉穿刺中央静脉置管后上肢深静脉血栓形成的临床观察

目的探讨经腋静脉穿刺中央静脉置管后上肢深静脉血栓形成情况。方法 2007年1月-2009年12月共收治60例需行中央静脉置管的患者,所有患者均通过腋静脉穿刺行中央静脉插管,并于拔除导管后行彩色多普勒超声检查了解双侧上肢深静脉血栓形成情况。将腋静脉穿刺侧上肢作为穿刺组,对侧上肢作为对照组,进行前瞻性对照研究,将两组上肢深静脉血栓发生率进行比较。结果 60例患者中央静脉置管平均时间为（14.7±7.4）d,对照组彩色多普勒超声检查无深静脉血栓形成,穿刺组2例患者出现上肢深静脉血栓形成的症状,无肺栓塞发生,28例患者（47%）拔除的导管周围可见纤维蛋白套形成,经上肢彩色多普勒超声检查,5例患者（8.3%）腋静脉不完全栓塞,2例患者（3.3%）腋静脉完全栓塞。在中央静脉置管时间≤6d的患者中,无上肢深静脉血栓形成;置管时间在7～14d的患者中,2例（3.3%）腋静脉血栓形成;5例（8.3%）腋静脉血栓形成发生在置管时间≥15d（P〈0.01）。7例腋静脉血栓形成患者,经2～3次穿刺成功,平均穿刺时间（10±2.5）min,与无腋静脉血栓形成患者的平均穿刺所需时间（14±9）min比较,无统计学意义（P〉0.05）。结论经腋静脉穿刺中央静脉置管后上肢深静脉血栓形成的发生率为11.6%。

Clinical Observation of Upper-extremity Deep Vein Thrombosis after Central Venous Catheterization via the Axillary Vein

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 2007to 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 28patients（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≤6days,two cases were observed for duration of 7-14days,and five cases were observed for duration of≥15days（P〈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.