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。

Prevention and Treatment of Deep Vein Thrombosis Induced by Peripherally Inserted Central Catheter

Objective To explore the ways to prevent and treat deep vein thrombus induced by peripherally inserted central catheter （PICC）. Methods We retrospectively reviewed the clinical data of 2 170 patients with PICC from Jun 2001 to Jun 2007, among whom there were 7 cases （6 patients） of deep vein thrombus （0.32%） and 2 cases of bacteremia. Clinical data, laboratory findings, and imaging presentations, treatment and followup results were recorded. Results All the 6 patients were with advanced carcinoma, concomitant with hypertension, coronary heart disease, diabetes, and hyperlipemia. All of them used the PICC made of polyurethane, and the 6 cases of the catheter position were placed in subclavical vein and 1 case of catheter position was placed in internal jugular vein. After thrombus formed as shown by ultrasound, the catheter was withdrawn and anticoagulation therapy was initiated. Superior vena filter was placed in 5 patients to prevent pulmonary embolism. During a mean follow-up of 10.6 months, the thrombus in 4 patients disappeared. Conclusions PICC can induce deep vein thrombus, which may result from inappropriate position of the tip of PICC. The route of cephalic vein should be avoided when putting catheters.