血栓弹力图在预防肺癌患者PICC相关性静脉血栓中的应用

目的 探讨血栓弹力图在预防肺癌患者经外周静脉置入中心静脉导管（peripherally inserted centralcatheters,PICC）相关性静脉血栓中的作用。方法 将264例肺癌患者按随机数字表法分为干预组和对照组各132例。干预组患者分别于PICC置管前1 d、置管后4周内每周检测1次血栓弹力图（thromboelastography,TEG）,血液高凝者行抗凝治疗。对照组患者按常规PICC置管,并于置管前1 d、静脉血栓形成后行TEG检测。2组患者均于PICC置管后4周内每周行血管超声检测1次,比较2组PICC相关性静脉血栓发生率、观察血液高凝状态者抗凝治疗前后TEG参数变化及静脉血栓者血栓形成前后TEG参数变化。结果 67例置管后血液高凝状态者行抗凝治疗后,TEG各参数与治疗前比较,均P＜0.05,差异有统计学意义;干预组PICC相关性静脉血栓发生率为0.76%、对照组为19.70%,2组相关性静脉血栓比较,χ2 = 25.791,P＜0.01,差异有统计学意义。26例静脉血栓形成者TEG参数与PICC置管前比较,均P＜0.05,差异有统计学意义。结论 采用TEG预测肺癌PICC患者静脉血栓,并建立个体化的抗凝治疗,可有效预防PICC相关性静脉血栓的形成,保证PICC临床应用安全。     

Peripherally inserted central catheters for parenteral nutrition: a comparison with centrally inserted catheters

BACKGROUND: Central venous access is crucial for the provision of adequate parenteral nutrition (PN). The type of central venous access device (CVAD) has evolved over the past 10 years. The most recent trend has been to use peripherally inserted central catheters (PICCs). This development has occurred without controlled clinical trials. METHODS: Over a 10-year period, the nutrition support service at a single institution has prospectively collected data on CVADs used for providing PN. The types of CVAD used for providing PN were analyzed, and the major complications associated with CVADs, thrombosis and line sepsis, were compared over three different time periods: 1988-1989; 1992-1993; 1996-1997. In addition, complications associated with PICCs were compared with other CVADs. RESULTS: The following were the dominant CVADs over each of the three time periods: 1988-1989: tunneled catheters, 80%; 1992-1993: nontunneled catheters, 46%; and 1996-1997: PICCs, 48%. There was a decreased incidence of sepsis and pneumothorax in 1996-1997 and an increase in severed or leaking catheters and phlebitis. In a comparison of PICC and non-PICC catheters over the past 3 years, there was a trend toward decreasing sepsis with PICC catheters but an increase in malposition, inadvertent removal, and severed or leaking catheters. CONCLUSIONS: PICCs have replaced tunneled and nontunneled central catheters as the most commonly used CVAD for providing PN. PICCs do not result in increased line sepsis or thrombosis but have an increased incidence of local complications such as leaking catheters, phlebitis, and malposition.     

Complications and cost associated with parenteral nutrition delivered to hospitalized patients through either subclavian or peripherally-inserted central catheters

BACKGROUND AND AIMS: Total parenteral nutrition (TPN) is typically delivered through catheters inserted into the superior vena cava (SVC) via a subclavian or internal jugular vein approach. A peripherally-inserted central venous catheter (PICC), utilizing a cephalic or basilic venous approach, may provide a safe alternative to the standard catheter approach and, because non-physician providers can insert the PICC, may introduce a potential cost-savings to health care institutions. We sought to determine if PICC lines are safer and more cost-effective than the standard central venous catheter approach for hospitalized patients who require TPN. METHODS: One hundred and two hospitalized patients (age range, 18-88 years) who required TPN were prospectively randomized to receive therapy via a centrally-inserted subclavian catheter (n=51) or a peripherally-inserted PICC line (n=51). The primary end-point was the development of a complication requiring catheter removal. Other end-points included catheter infection and thrombophlebitis. Cost associated with insertion and maintenance of each catheter was also studied. RESULTS: Complication-free delivery rate (without the need to remove or replace the catheter) was 67% for subclavian catheters and 46% for PICC lines (P<0.05). The overall infection rate was 4.9 per 1000 catheter days and was similar for each catheter type (P=0.68). PICC lines were associated with higher rates of clinically-evident thrombophlebitis (P<0.01), difficult insertion attempts (P<0.05), and malposition on insertion (P<0.05). No catheter complications resulted in significant long-term morbity or mortality. No significant difference was noted between the two catheter types in terms of aborted insertion attempts (P=0.18), dislodgement (P=0.12), or line occlusion (P=0.25). After standardizing costs for each hospital, the direct institutional costs for insertion and maintenance of PICC lines (US$22.32+/-2.74 per day) was greater than that for subclavian lines (US$16.20+/-2.96 per day;P<0.05). CONCLUSION: PICC catheters have higher thrombophlebitis rates and are more difficult to insert into certain patients when compared to the standard subclavian approach for central venous access in hospitalized patients who require TPN. Because of this, PICCs may be less cost-effective than currently believed because of the difficulty in inserting and maintaining the catheter.     

阿司匹林干预对肺癌化疗患者PICC置管后血栓发生率的影响:997例回顾性研究

目的 观察阿司匹林干预对肺癌化疗患者PICC置管后血栓发生的影响。方法 选择2007年12月至2012年6月在上海市胸科医院PICC置管的肺癌患者997 例,根据入院时间分为两组,2007年12月至2011年10月为对照组（n=562）,2011年11月至2012年6月为研究组（n=435）。对照组采用传统置管方法,生理盐水封管。研究组采用改良式置管技术,拜阿司匹林口服,肝素钠稀释液封管。结果 对照组23例患者（4.09%）发生血栓,研究组13例（2.99%）。对照组17例在置管后1周内发生血栓,3例在1周至1个月间发生血栓,3例1个月后发生血栓;研究组4例在置管后1周内发生血栓,5例在1周至1个月间发生血栓,4例1个月后发生血栓,两组血栓发生时间差异有统计学意义（Z=-2.221,P=0.026）。对照组17例血栓发生在外周浅静脉,6例在锁骨上静脉及颈内静脉;研究组5例在外周浅静脉,8例在锁骨上静脉及颈内静脉,血栓部位的组间差异也有统计学意义（Z=-2.066,P=0.039）。结论 预防性口服拜阿司匹林可有效控制肺癌化疗患者PICC置管后血栓发生     

The optimal duration of anticoagulation in patients with venous thromboembolism: how long is long enough?

The risk of recurrent venous thromboembolism (VTE) approaches 40% of all patients after 10 years of follow-up. This risk is higher in patients with permanent risk factors of thrombosis such as active cancer, prolonged immobilization from medical diseases, and antiphospholipid syndrome; in carriers of several thrombophilic abnormalities, including deficiencies of natural anticoagulants; and in patients with unprovoked presentation. Patients with permanent risk factors of thrombosis should receive indefinite anticoagulation, consisting of subtherapeutic doses of low-molecular-weight heparin in cancer patients, and oral anticoagulants in all other conditions. Patients whose VTE is triggered by major surgery or trauma should be offered three months of anticoagulation. Patients with unprovoked VTE, including carriers of thrombophilia, and those whose thrombotic event is associated with minor risk factors (such as hormonal treatment, minor injuries, long travel) should receive at least three months of anticoagulation. The decision as to go on or discontinue anticoagulation after this period should be individually tailored and balanced against the haemorrhagic risk. Post-baseline variables, such as the D-dimer determination and the ultrasound assessment of residual thrombosis can help identify those patients in whom anticoagulation can be safely discontinued. As a few emerging anti-Xa and anti-IIa compounds seem to induce fewer haemorrhagic complications than conventional anticoagulation, while preserving at least the same effectiveness, they have the potential to open new scenarios for decisions regarding the duration of anticoagulation in patients with VTE.     

阿司匹林对经外周静脉置入中心静脉导管相关性血栓的预防作用

目的评估阿司匹林对经外周静脉置入中心静脉导管（PICC）相关性血栓的预防作用。方法将360例接受PICC置管的肿瘤患者随机分为对照组和试验组两组,每组180例。对照组按照常规方法进行PICC置管后,给予常规PICC导管维护;试验组除按照常规进行PICC置管,给予常规PICC导管维护外,给予100mg阿司匹林每日1次口服,连续21d。观察两组患者的静脉炎和血栓发生情况。结果试验组患者的静脉炎和血栓发生率分别为3．3％和0,明显低于对照组的8．9％（P=0．025）和1．7％（P=0．025）。结论PICC置管后给予口服阿司匹林可降低PICC相关性血栓和静脉炎的发生。     

Percutaneous, tunneled silicone elastomer central venous catheters for total parenteral nutrition: low sepsis and thrombosis rate. A prospective study of 315 catheters

Silastic catheters were inserted by the percutaneous route, and tunneled subcutaneously, in 315 patients who needed venous access for total parenteral nutrition. The catheters were managed with a daily program that included heat sterilization of the metal hub with an electrical soldering iron. This study aimed to evaluate prospectively the incidence of catheter-related sepsis and thrombosis. There was one case of pneumothorax. All catheters were x-rayed post-insertion: eight catheters were malpositioned initially. The median catheter duration was 18 days with a range of 2-138 days. The total duration was 240 catheter-months. Twenty-seven catheters were removed due to mechanical problems. Nine were removed because of suspected sepsis; six patients had negative blood and catheter cultures, while three grew pathogens. The sepsis rate was thus 0.95%. There were no clinical signs of thrombosis. Pull-out venography was performed in 93 patients. Fibrin sleeves were seen in the majority of cases. Two patients had wall-adherent, non-occlusive thrombus masses (2%); they both had proximal catheter positions. We conclude that there is a low risk of catheter-related sepsis and thrombosis with this technique.     

压力抗栓泵预防骨科患者下肢静脉血栓形成的效果研究

目的:分析压力抗栓泵预防骨科患者下肢静脉血栓形成的临床疗效。方法:选取2018年1月~2018年12月本院骨科收治的35例股骨粗隆骨折患者作为对照组,术后采用常规抗凝治疗措施,另选取同期收治的35例股骨粗隆骨折患者作为试验组,在常规抗凝治疗的基础上采用压力抗栓泵进行治疗,观察两组患者治疗后的凝血指标、下肢深静脉血栓发生率以及髋关节功能评分。结果:两组患者的各项凝血指标差异均无统计学意义(P>0.05);试验组患者的下肢深静脉血栓发生率为2.86%(1/35),低于对照组患者的14.29%(5/35),差异具有统计学意义(P<0.05);试验组患者治疗后的髋关节功能评分为(91.62±7.28),优于对照组患者的(84.15±6.64),差异具有统计学意义(P<0.05)。结论:对于股骨粗隆骨折患者术后采用压力抗栓泵进行治疗有助于降低下肢深静脉血栓发生率,改善髋关节功能,有助于患者早日康复。     

Catheter thrombosis and superior/inferior vena cava syndrome are rare complications of long term parenteral nutrition

The objective of this study was to determine the incidence of catheter thrombosis and superior/inferior vena cava (SVC IVC ) syndrome in a large population of patients receiving home total parenteral nutrition (TPN), using retrospective data collection and analysis. 527 patients including 138 children who were discharged on home TPN and followed in the UCLA home TPN program for a minimum of one week between April, 1973 and October, 1991. There was a total of 1154 years of patients follow-up, including 241 years in children. Fifty-seven patients (11%) developed 81 episodes of catheter thrombosis excluding SVC IVC syndrome with an incidence of 0.07 episodes per catheter year. The median catheter duration prior to thrombosis was 7 months. Twenty-one thromboses occured in children with an incidence of 0.09 per catheter year. Eleven percent of thrombotic episodes were associated with catheter sepsis. Thirty-nine percent of patients had a PTT less than control values. Twenty-two patients including 6 children developed SVC IVC syndrome with an incidence of 0.02 per catheter year. SVC IVC syndrome was not associated with catheter sepsis in any patient. Sixty-eight percent of patients had catheter thrombosis at some point prior to developing SVC IVC syndrome. It is concluded that catheter-related thrombotic events are rare complications of home TPN and are uncommonly associated with infection. However, we recommend warfarin anticoagulation following an initial thrombotic event, in the absence of catheter malposition, for all such patients as long as they maintain a central venous catheter.     

Central venous access in the home parenteral nutrition population-you PICC

BACKGROUND: Central venous access is imperative for the delivery of home parenteral nutrition (HPN). Peripherally inserted central catheters (PICC) are being used more frequently for the delivery of HPN. There is an abundance of short-term information on the use of PICC in the hospitalized patient. However, there are no data comparing the use of PICC to other central venous access devices (OCVAD; Hickman, port) for the delivery of HPN. Catheter-related infections (CRI) are the most common cause of hospital readmission for the HPN patients. METHODS: A retrospective analysis was performed from the Digestive Disease Center HPN database at the Medical University of South Carolina and the open architecture clinical information system (OACIS) hospital and clinic reporting system. All CRI were analyzed and compared between patients with PICC and OCVAD. The PICC group and the OCVAD group were further broken down into diabetic patients and nondiabetic patients, and the incidence of CRI was compared within those groups. RESULTS: HPN patients with PICC had a statistically significant increase (p < .01) of CRI as compared with OCVAD within our HPN patients. There was no statistically significant increase in CRI between diabetic and nondiabetic patients. CONCLUSIONS: The use of PICC for HPN may be associated with an increase in CRI. A prospective, randomized trial in the HPN population between PICC and OCVAD must be performed.     

乳腺癌化疗患者外周置人中心静脉导管相关上肢静脉血栓形成的临床诊疗

目的探讨乳腺癌化疗患者外周置人中心静脉导管（PICC）相关上肢静脉血栓形成的临床诊疗。方法回顾性分析北京协和医院2011至2012年938例乳腺癌化疗患者中,PICC相关有症状上肢静脉血栓形成的发生率、诊断和治疗。结果10例乳腺癌患者出现PICC相关有症状上肢静脉血栓,发生率为1．1％（10/938）,每1000个导管留置日中的血栓例数为0．11,共携带导管1035d,置管后血栓发生中位时间23．5（4～176）d,9例患者采用低分子肝素抗凝,中位抗凝时间为14（3～50）d,5例患者抗凝后继续使用导管,所有患者均无肺栓塞发生。结论PICC相关上肢静脉血栓形成在乳腺癌化疗患者中发生率低,早期诊断及治疗后,仍可取得较好的临床结局。     

Portal vein thrombosis: an unexpected finding in a 28-year-old male with abdominal pain.

BACKGROUND: Abdominal pain is a common primary care complaint. Portal vein thrombosis (PVT) is a rare cause of abdominal pain, typically associated with cirrhosis or thrombophilia. The following describes the presentation of PVT in a young male, the search for risk factors and underlying etiology, and the debate of anticoagulation therapy. CASE: A 28-year-old male presented with periumbilical pain, post-prandial nausea, and sporadic hematemesis for 3 weeks. The diagnosis was confirmed with a triphasic liver computerized tomography after obtaining an abnormal right upper quadrant ultrasound. This unexpected finding prompted investigation for intrinsic hepatic disease and potential hypercoagulable disorders. Laboratory analysis revealed a heterozygous genotype for the prothrombin 20210G/A mutation, an identified risk factor for venous thrombosis. DISCUSSION: Recommendations concerning anticoagulation for PVT in the absence of cirrhosis are not clearly defined. Current literature describes the following factors as indications for anticoagulation: acute thrombus, lack of cavernous transformation, absence of esophageal varices, and mesenteric venous thrombosis. This patient had clinical indications both for and against anticoagulation. Weighing this individual's clinical circumstances, we concluded the risk of thrombus in the setting of a hypercoagulable disorder outweighed the risk of variceal bleeding. A minimum of 6 months of anticoagulation was initiated. CONCLUSION: PVT is an uncommon cause of abdominal pain, and the absence of hepatic disease should raise the index of suspicion for an underlying thrombophilia. Specific recommendations for anticoagulation are not well defined, demonstrating the importance of weighing the individual risks and benefits in treatment with anticoagulation for young persons with thrombophilia.     

成人家庭肠外营养患者PICC导管相关血流感染发病率的Meta分析

 目的 比较成人家庭肠外营养(HPN)患者经外周静脉穿刺置入中心静脉导管(PICC)与中心静脉导管(CVC)的导管相关血流感染(CRBSI)发病率,为HPN患者选择合适的静脉血管通路装置提供证据支持。方法 计算机检索Cochrane图书馆、JBI图书馆、Pubmed、Embase、Ovid、Web of Science、中国生物医学文献数据库、维普数据库、万方及中国知网建库至2019年3月关于HPN患者CRBSI发病率的研究,应用Stata 13.0进行Meta分析。结果 共纳入9篇队列研究文献,1 407例患者。Meta分析结果显示,使用PICC的HPN患者CRBSI发病率低于CVC (12.14% VS 37.18%,RR=0.42,95%CI:0.34~0.52)。有6篇文献报道CRBSI日发病率,结果显示PICC的CRBSI发病率低于CVC(12.97% VS 37.21%,RR=0.37,95%CI:0.23~0.60)。亚组分析结果显示,不同PICC置管方式组(超声引导、X线检查、未报道组)、报道CRBSI的诊断方法组、不同血管导管使用日数组(报道和未报道组)、报道感染菌群种类组PICC患者CRBSI发病率均低于CVC患者,差异均有统计学意义(均P<0.05)。结论 与CVC相比,成人HPN患者选择PICC进行治疗时CRBSI的发生风险较低。     

Use of deep venous thrombosis prophylaxis by family physicians.

BACKGROUND: Accumulated data indicate that the administration of low-dose subcutaneous heparin reduces the incidence of deep venous thrombosis in high-risk surgical and medical patients. Because deep venous thrombosis predisposes to pulmonary embolism, it is generally accepted that reducing deep venous thrombosis will reduce pulmonary embolism, the most common preventable cause of death in hospitalized patients. There are few data, however, regarding physicians' use of heparin for deep venous thrombosis prophylaxis in medical patients. METHODS: We reviewed charts of medical patients aged 50 years and older who were admitted to family practice services in a community teaching hospital and excluded patients who were not candidates for heparin prophylaxis. RESULTS: Eighty (65 percent) of 123 patients received heparin for deep venous thrombosis prophylaxis. Patients admitted to a residency teaching service were more likely to receive heparin for deep venous thrombosis prophylaxis than were patients admitted to nonteaching services (odds ratio 3.37, 95 percent confidence interval 1.26-9.21, P = 0.012). An association between the patient's number of risk factors for deep venous thrombosis and likelihood of receiving deep venous thrombosis prophylaxis approached statistical significance (P = 0.078). CONCLUSIONS: In our institution, heparin for deep venous thrombosis prophylaxis is frequently but not uniformly prescribed for appropriately selected family practice inpatients. No similar data for nonsurgical patients were found for comparison.     

经外周中心静脉置管导致深静脉血栓并发症的防治

目的分析经外周至中心静脉置管导致深静脉血栓形成的临床病例原因，探讨治疗和预防的方法。方法回顾我院2001年6月～2007年6月留置经外周中心静脉置管（PICC）2170例，6例发生相关深静脉血栓并发症7例次（0．32％），其中2例合并菌血症，记录相关临床资料、实验室和影像学检查及治疗手段，并进行随访。结果6例患者均为晚期肿瘤，分别合并高血压、冠心病、糖尿病和高脂血症，均使用聚脲氨酯材质的PICC导管，管尖位置6例次在锁骨下静脉、1例次在颈内静脉；超声确诊血栓形成后，拔出导管并抗凝治疗，5例患者放置上腔静脉滤器预防肺动脉栓塞，平均随访10．6个月，4例血栓消失。结论PICC可导致深静脉血栓并发症，其主要原因是管尖位置不当，置管时应尽量避免选择头静脉途径。     

高频超声联合腹部彩色多普勒超声诊断下肢静脉血栓的临床分析

目的:分析高频超声联合腹部彩色多普勒超声诊断下肢静脉血栓的临床应用效果。方法:选取2017年2月~2018年6月本院收治的下肢静脉血栓患者62例为研究对象,所有患者均行高频超声联合腹部彩色多普勒超声诊断,再行血管造影检查诊断,以血管造影检查诊断为金标准,观察高频超声联合腹部彩色多普勒超声的诊断正确率,同时对高频超声联合腹部彩色多普勒超声的诊断结果进行分析。结果:以血管造影检查诊断为诊断依据,高频超声联合腹部彩色多普勒超声的诊断正确率为96.77%(60/62),漏诊率为3.23%(2/62);血栓部位情况:单纯深静脉血栓15例,单纯浅表静脉血栓16例,单纯小腿段肌肉间静脉血栓20例,下肢静脉血栓伴小腿段肌肉间静脉血栓17例;血栓特征情况:慢性血栓28例,急性血栓15例,亚急性血栓17例。结论:下肢静脉血栓行高频超声联合腹部彩色多普勒超声诊断具有较高的诊断正确率,能有效了解患者的血栓部位以及特征,为治疗提高可靠的依据。     

Site-rite5超声系统在PICC置管中的应用

目的：探讨Site-rite 5超声系统在PICC置管中的应用价值。方法：对需要长期静脉治疗且静脉置管困难者在Site-rite 5超声系统导引下行PICC置管,观察穿刺成功率、穿刺次数、穿刺时间、静脉炎发生率、血栓发生率、患者的疼痛评分。入选标准：肘部血管无法触及的肥胖患者、长期化疗4～6周期以后、长期静脉治疗外周血管损伤者、患有心血管疾病的老年患者（80岁以上）、小儿患者（7岁以下）。结果：置管成功率为100%,大大减少了穿刺次数,缩短了穿刺时间,避免了静脉炎和血栓的发生,减轻了患者的疼痛。结论：Site-rite 5超声系统是一种实用、科学、直观的用于PICC置管的仪器,值得在临床推广。     

Sleeve thrombus fibrosis causing neck pain

BACKGROUND: Central venous catheter occlusion due to thrombus formation is the most common cause for malfunction of long-term indwelling catheters. The exact pathology and pathogenesis of this common complication is misunderstood because of an array of terms being used interchangeably in the literature. This article identifies the pathogenesis and symptoms and gives suggestions for the treatment of central venous catheter-related thrombosis. METHODS: Our case report is of a girl who had a percutaneously placed left subclavian central venous line attached to her vascuport. After 9 months she developed severe pain over the catheter tubing on injection into the port. Surgical exploration of the catheter tubing in the infraclavicular region demonstrated that the pain was due to retrograde flow around the catheter within a sleeve thrombus. CONCLUSIONS: In this type of patient, all precautions should be taken to minimize the risk of thrombus formation, including considering the prophylactic use of anticoagulants.     

不同部位行静脉PICC置管的临床比较

目的:探讨不同部位行静脉PICC置管的临床疗效比较。方法:搜集2016年7月~2018年9月在本院行PICC治疗的126例长期输液肿瘤患者的病历资料进行回顾性分析,其中将实施肘上部置管的66例患者作为肘上组,60例肘下部置管的患者作为肘下组,观察两组患者在肿瘤科长期输液患者置管过程中的并发症发生率以及患者的舒适度,并进行对比分析。结果:①肘上组置管并发症发生率(12.1%)较肘下组(26.7%)低,P<0.05;②肘上置管组患者舒适度更高,χ~2=20.225,P<0.05。结论:长期输液患者PICC置管中,肘上置管较肘下置管能降低置管并发症、提高患者舒适度,如患者条件适合,可作为PIC置管首选部位。     

69例临时中心静脉透析导管患者的临床分析

目的通过分析69例临时中心静脉置管血液透析患者的相关临床资料,探讨其临床运用的优缺点。 方法选择常州市武进人民医院血液净化中心2017年1月至12月新留置临时中心静脉导管进行血液透析的69例患者为研究对象,进行回顾性病例分析研究,其中男性42例,女性27例;年龄20～89岁,平均(61.06±15.09)岁。统计并记录69例患者的原发疾病、导管留置部位与时间、导管相关性感染以及导管血栓形成情况、疾病转归。对比分析不同的置管部位对血液透析治疗效果和安全性的影响。 结果69例临时中心静脉置管患者的原发疾病主要为慢性肾炎30例(43.48%)、肿瘤相关性肾病12例(17.39%)、糖尿病肾病9例(13.04%)等,直接直观原因包括急性肾衰竭17例(24.63%)、慢性肾衰竭首次透析内瘘未成熟43例(62.32%)以及内瘘失功9例(13.04%)。14例(20.29%)患者死亡、7例(10.14%)患者好转、33例(47.83%)转为长期血液透析、5例(7.25%)转为腹膜透析、1例(1.45%)患者放弃治疗。4例(5.79%)患者出现了导管相关性感染,感染率为1.47次/1 000导管日;12例(17.39%)患者发生血栓形成,其中3例(25.00%)溶栓无效,重新置管,余9例(75.00%)患者经溶栓治疗可维持适当的血流量,9例溶栓患者的平均溶栓次数为(3.44±1.84)次。69例临时中心静脉置管血液透析患者中,选择颈内静脉和股静脉的患者分别为39例(56.52%)和30例(43.48%),不同部位导管的留置时间无差异[(39.64±25.43)比(38.86±26.77)d,P>0.05],但颈内静脉置管的导管相关性感染率(0.65次/1 000导管日比2.57次/1 000导管日)和血栓形成率[5.13%(2/39)比33.33%(10/30),P<0.05]均低于股静脉置管。 结论临时中心静脉置管为透析患者第一时间建立了安全、快捷、可靠的临时血管通路,在临床运用中值得推广;但临时中心静脉透析导管也增加了透析患者的感染率及血栓形成率。