切换至 "中华医学电子期刊资源库"
高级检索
中华诊断学电子杂志

中华诊断学电子杂志 ›› 2017, Vol. 05 ›› Issue (03) : 179 -182. doi: 10.3877/cma.j.issn.2095-655X.2017.03.010

所属专题： 文献；

重症超声

中心静脉置管术后静脉血栓形成的超声诊断及相关因素分析
李志莲1, 余永森2, 杨莉3,†(), 谢琦2   
  1. 1. 510000　广州市第一人民医院南沙医院影像科
    3. 510120　广州，中山大学孙逸仙纪念医院心内科
  • 收稿日期:2017-04-17 出版日期:2017-08-26
  • 通信作者: 杨莉
  • 基金资助:
    广东省科技计划社会发展项目(20128031800049)

Ultrasonic diagnosis of venous thrombosis associated with peripherally inserted central venous catheters and the analysis of related factors

Zhilian Li1, Yongsen Yu2, Li Yang3,†(), Qi Xie2   

  1. 1. Department of Medical Imaging, Nan Sha Center Hospital, Guangzhou First Municipal People′s Hospital, Guangzhou 510000, China; Department of Cardiology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou 510120, China
    2. Department of Medical Imaging, Nan Sha Center Hospital, Guangzhou First Municipal People′s Hospital, Guangzhou 510000, China
    3. Department of Cardiology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou 510120, China
  • Received:2017-04-17 Published:2017-08-26
  • Corresponding author: Li Yang
  • About author:
    Corresponding author: Yang Li, Email:
全文 ( ) 下载PDF ( ) 导出引用
引用本文：

李志莲, 余永森, 杨莉, 谢琦. 中心静脉置管术后静脉血栓形成的超声诊断及相关因素分析[J]. 中华诊断学电子杂志, 2017, 05(03): 179-182.

Zhilian Li, Yongsen Yu, Li Yang, Qi Xie. Ultrasonic diagnosis of venous thrombosis associated with peripherally inserted central venous catheters and the analysis of related factors[J]. Chinese Journal of Diagnostics(Electronic Edition), 2017, 05(03): 179-182.

目的

探讨高频彩色多普勒超声(彩超)对中心静脉置管(PICC)术后静脉血栓形成的诊断价值，并对血栓形成的相关因素进行分析。

方法

连续收集广州市第一人民医院超声科2016年6月至12月PICC术后拟诊静脉血栓形成而接受高频彩超检查的83例患者。使用美国GE Vivid E9超声诊断仪高频探头对PICC置管部位及其相邻的近远段血管进行探查，对血栓检出情况及患者的相关资料(性别、年龄、基础疾病、置管时长、置管途径)进行回顾性分析。

结果

50例(60.2%)患者PICC置管部位或邻近静脉高频彩超检查发现血栓。置管后2周内血栓检出率(64.0%)高于2周以上(36.0%)，但差异无统计学意义(χ2＝0.74，P>0.05)。50岁以上脑血管意外和恶性肿瘤患者的血栓检出率(64.0%)高于其他患者(36.0%)，差异有统计学意义(χ2＝5.97，P<0.05)。

结论

高频彩超对诊断PICC相关静脉血栓形成有重要价值；PICC术后2周内可能是静脉血栓形成的高发期，50岁以上的脑血管意外和恶性肿瘤患者是PICC术后血栓发生的高危人群，建议对此类患者及时进行高频彩超检查，以利早期诊断、治疗。

关键词: 中心静脉置管, 静脉血栓形成, 超声检查，多普勒，彩色
Objective

To investigate the diagnostic value of high frequency color Doppler ultrasonography in venous thrombosis associated with peripherally inserted central catheters(PICC), and to analyze the risk factors related to thrombosis.

Methods

A total of 83 patients were consecutively collected, who were suspected to be afflicted with venous thrombosis following PICC and underwent the examinaiton of color Doppler ultrasonography between June and December 2016, in Guangzhou First Municipal People′s Hospital.All the PICC-related veins were observed using GE Vivid E9 ultrasonic diagnostic equipment with high frequency probe.Clinical data of all cases (sex, age, underlying disease, duration and site of catheterization) and the detection of thrombus were retrospectively analysed.

Results

Thrombus was detected by high frequency color Doppler ultrasonography in PICC-related veins in 50 (60.2%) cases.The rate of thrombus detection (64.0%) within 2 weeks of venous catheterization was higher than that over 2 weeks (36.0%), but the difference was not statistically significant (χ2=0.74, P>0.05). Thrombus was found more often in patients over 50 years old with cerebrovascular accident and malignant tumor (64.0%), compared with that in other patients (36.0%, χ2=5.97, P<0.05).

Conclusions

High frequency color Doppler ultrasonography has important diagnostic value for PICC-related venous thrombosis.The thrombosis may occur more often within 2 weeks of PICC catheterization.Patients over 50 years old with cerebrovascular accident and malignant tumor are at higher risk of venous thrombosis following PICC, and are suggested to receive color Doppler ultrasonography timely with the aim of early diagnosis and treatment.

Key words: Peripherally inserted central venous catheters, Venous thrombosis, Ultrasonography, doppler, color
图1 中心静脉置管术后患者血管高频彩超图像。a图示颈内静脉置管术后血栓形成，管腔完全阻塞，无血流信号通过(箭头所示)；b图示贵要静脉置管术后血栓形成，管腔不完全阻塞，管腔内血流束变窄(箭头所示)
表1 50例PICC术后静脉血栓患者的置管途径及置管时长(例，%)
置管途径 置管时长 合计
≤2周(n＝32) >2周(n＝18)
贵要静脉 19(38.0) 9(18.0) 28(56.0)
肱静脉 1(2.0) 4(8.0) 5(10.0)
颈内静脉 5(10.0) 1(2.0) 6(12.0)
锁骨下静脉 4(8.0) 3(6.0) 7(14.0)
股总静脉 3(6.0) 1(2.0) 4(8.0)
合计 32(64.0) 18(36.0) 50(100.0)
表2 50例PICC术后静脉血栓患者按年龄及基础疾病分组比较(例，%)
年龄 脑血管意外＋恶性肿瘤(n＝39) 其他疾病(n＝11)
≤50岁 7(14) 6(12)
>50岁 32(64) 5(10)
χ2值 5.97 ?
P值 <0.05 ?
[1]
朱屹华,赵勇. PICC在临床的应用及发展方向[J]. 吉林医学, 2013, 34(22): 4610.
[2]
Chopra V,Anand S,Hickner A, et al.Risk of venous thromboembolism associated with peripherally inserted central catheters：a systematic review and meta-analysis[J]. Lancet, 2013, 382(9889): 311-325.
[3]
彭星宇,方汉萍. PICC相关性静脉血栓危险因素及预防措施研究进展[J]. 齐鲁护理杂志, 2016, 22(3): 54-56.
[4]
王乔凤,岑敏琼,柯春连. 我科PICC置管术后并发症分析与对策[J]. 护理管理杂志, 2012, 12(3): 206, 216.
[5]
Klitfod L,Broholm R,Baekgaard N. Deep venous thrombosis of the upper extremity.A review[J]. Int Angiol, 2013, 32(5): 447-452.
[6]
Kato A,Takano H,Ichikawa A, et al.A retrospective cohort study of venous thromboembolism(VTE) in 1035 Japanese myeloma patients treated with thalidomide; lower incidence without statistically significant association between specific risk factors and development of VTE and effects of thromboprophylaxis with aspirin and warfarin[J]. Thromb Res, 2013, 131(2): 140-144.
[7]
Ong B,Gibbs H,Catchpole I, et al.Peripherally inserted central catheters and upper extremity deep vein thrombosis[J]. Australas Radiol, 2006, 50(5): 451-454.
[8]
Aw A,Carrier M,Koczerginski J, et al.Incidence and predictive factors of symptomatic thrombosis related to peripherally inserted central catheters in chemotherapy patients[J]. Thromb Res, 2012, 130(3): 323-326.
[9]
Ahn DH,Illum HB,Wang DH, et al.Upper extremity venous thrombosis in patients with cancer with peripherally inserted central venous catheters：a retrospective analysis of risk factors[J]. J Oncol Pract, 2013, 9(1): 8-12.
[10]
Yi XL,Chen J,Li J, et al.Risk factors associated with PICC-related upper extremity venous thrombosis in cancer patients[J]. J Clin Nurs, 2014, 23(5-6): 837-843.
[11]
吴红娟,陈雪峰,张美英, 等. 肿瘤患者PICC置管主要并发症及其相关因素分析[J]. 中华护理杂志, 2008, 43(2): 134-135.
[12]
King MM,Rasnake MS,Rodriguez RG, et al.Peripherally inserted central venous catheter-associated thrombosis：retrospective analysis of clinical risk factors in adult patients[J]. South Med J, 2006, 99(10): 1073-1077.
[13]
Chemaly RF,de Parres JB,Rehm SJ, et al.Venous thrombosis associated with peripherally inserted central catheters：a retrospective analysis of the cleveland clinic experience[J]. Clin Infect Dis, 2002, 34(9): 1179-1183.
[14]
Nash EF,Helm EJ,Stephenson A, et al.Incidence of deep vein thrombosis associated with peripherally inserted central catheters in adults with cystic fibrosis[J]. J Vasc Interv Radiol, 2009, 20(3): 347-351.
[15]
白玲,王勇,陈翠京, 等. PICC置管术后上肢静脉血栓113例诊治分析[J]. 人民军医, 2015, 58(9): 1087-1089.
[16]
张秀玲,柳建华. 彩超对肿瘤患者PICC术后上肢静脉血栓的诊断价值[J]. 临床医学工程, 2015, 22(2): 153-154, 159.
[17]
吴长福,孙培栋,毕振宇, 等. 上肢静脉入路PICC置管术应用解剖学研究[J]. 护理学报, 2011, 18(19): 8-11.
[18]
张洪臣.1500例老年人凝血指标分析[J]. 血栓与止血学, 2004, 10(1): 25.
[19]
郝轶,吐尔逊娜依·阿迪,穆玉明. 超声观察锁骨下静脉穿刺置管术后血栓形成因素[J]. 中国介入影像与治疗学, 2009, 6(2): 130-133.
[20]
李欣茹,孙建霞,张靓, 等. 超声诊断左颈内静脉血栓1例[J]. 中国医学影像技术, 2010, 26(8): 1514.
[21]
Kimata H,Yoshida A,Ishioka C, et al.Nerve growth factor specifically induces human IgG4 production[J]. Eur J Immunol, 1991, 21(1): 137-141.
[22]
刘聿秀,高玉芳. PICC相关上肢静脉血栓的研究进展[J]. 护理学报, 2010, 17(9): 14-17.
[23]
Fletcher JJ,Stetler W,Wilson TJ.The clinical significance of peripherally inserted central venous catheter-related deep vein thrombosis[J]. Neurocrit Care, 2011, 15(3): 454-460.
[1] 李保启, 王佳佳, 王金萍, 伍宏兵. 肝豆状核变性患者脾切除术后门静脉系统血栓形成的危险因素分析[J]. 中华医学超声杂志（电子版）, 2022, 19(08): 818-822.
[2] 肖志满, 龚煜, 谢景凌, 刘斌伟. 上下肢关节镜手术后患者下肢深静脉血栓发生的对比研究[J]. 中华关节外科杂志(电子版), 2023, 17(05): 601-606.
[3] 邵长杰, 杜晓颖, 徐奎帅, 张靓, 纪岩磊. 住院天数影响全膝关节置换术后下肢深静脉血栓形成[J]. 中华关节外科杂志(电子版), 2023, 17(04): 588-591.
[4] 张程, 何海军, 张光熠, 熊冰朗, 田天照, 孙诗艺, 吴子轩. 抗凝剂预防膝关节镜术后血栓发生的Meta分析[J]. 中华关节外科杂志(电子版), 2023, 17(03): 340-347.
[5] 秦茜羽, 唐英, 于珍, 杨海波, 杨洁. 婴幼儿腹股沟卵巢疝临床分析并文献复习[J]. 中华妇幼临床医学杂志(电子版), 2023, 19(02): 227-234.
[6] 陈川, 杨太珠, 何泽凤. 肾脏彩色多普勒超声结果对儿童重症医学科急性肾损伤患儿的辅助诊断价值[J]. 中华妇幼临床医学杂志(电子版), 2023, 19(02): 219-226.
[7] 黄应雄, 叶子, 蒋鹏, 詹红, 姚陈, 崔冀. 急性肠系膜静脉血栓形成致透壁性肠坏死的临床危险因素分析[J]. 中华普通外科学文献(电子版), 2023, 17(06): 413-421.
[8] 王振国, 谢正宇, 圣磊, 田径. 彩色多普勒超声联合多层螺旋CT诊断腹股沟斜疝、直疝及股疝的价值[J]. 中华疝和腹壁外科杂志(电子版), 2023, 17(03): 330-333.
[9] 宋碧萱, 郭海川, 韩子钰, 周瑞娟, 李承思, 姬晨妮. 开放式楔形胫骨高位截骨术后下肢深静脉血栓形成的危险因素分析及预测列线图的构建[J]. 中华老年骨科与康复电子杂志, 2023, 09(04): 226-232.
[10] 夏志强, 周强, 李颖, 李飞龙, 赵磊, 王肇炜, 朱晓曼. 老年膝关节置换围手术期深静脉血栓形成因素分析及其血清预测因子分析[J]. 中华老年骨科与康复电子杂志, 2022, 08(06): 361-366.
[11] 吴枫, 刘晓璐, 王谦, 徐娟. 彩色多普勒超声对胃间质瘤的诊断价值[J]. 中华消化病与影像杂志(电子版), 2023, 13(04): 229-231.
[12] 贺芳. 易栓症和子痫前期[J]. 中华产科急救电子杂志, 2023, 12(01): 6-11.
[13] 陈真, 漆洪波. 易栓症与胎儿生长受限[J]. 中华产科急救电子杂志, 2023, 12(01): 18-21.
[14] 郑景达, 黄金旗, 张庆贤, 陈煌, 高晓杰. 小腿深静脉入路AngioJet一站式血栓清除治疗全肢型急性下肢深静脉血栓形成患者的临床研究[J]. 中华介入放射学电子杂志, 2023, 11(04): 305-309.
[15] 张德伟, 雷毅, 江哲宇, 王黎洲, 许国辉, 周石. 杂交手术治疗下肢深静脉血栓合并下肢急性动脉血栓一例[J]. 中华介入放射学电子杂志, 2023, 11(04): 380-384.
阅读次数
全文


摘要

版权所有 中华医学会 中华医学电子音像出版社有限责任公司  京ICP备14006079号-1  网络出版服务许可证：(署)网出证(京)字第075号