定期超声检查在中心静脉置入设备相关深静脉血栓诊治中的应用价值

doi:10.6040/j.issn.1671-7554.0.2020.1717

摘要/Abstract

摘要： 目的探讨定期超声检查在中心静脉置入设备相关深静脉血栓诊治中的应用价值。方法选取2018年5月至2019年9月于哈励逊国际和平医院应用中心静脉置入设备(CVAD)肿瘤患者440例,按随机数字表法分为观察组(n=221)和对照组(n=219)。观察组每隔3周超声检查记录是否出现中心静脉置入设备相关深静脉血栓(CRDVT),对照组则在出现临床症状后行超声检查诊断是否存在CRDVT,对两组确诊的CRDVT患者,进行不少于90 d的超声评估直至CVAD去除,记录治疗过程中是否存在血栓复发。比较两组间CRDVT诊断率、非计划CVAD去除率、血栓复发率以及血栓后综合征(PTS)发生率。结果两组基本资料差异均无统计学意义(P>0.05)。观察组CRDVT诊断率为9.5%(21例),对照组CRDVT诊断率为4.6%(10例),两组间CRDVT诊断率差异有统计学意义(χ2=4.092,P=0.043);观察组CVAD非计划去除率为0.9%(2例),对照组CVAD非计划去除率为4.1%(9例),两组CVAD非计划去除率差异有统计学意义(χ2=4.634,P=0.031);观察组和对照组CRDVT患者90d的累积血栓复发率分别为15.3%和10.0%,两组累积血栓复发率差异无统计学意义(Logrank=0.003,P=0.953);观察组和对照组CRDVT患者血栓后综合征发生率分别为4.7%和40%,两组间PTS发生率差异有统计学意义(χ2=3.886,P=0.049)。结论定期超声检查可以提高CRDVT的诊断率,减少非计划CVAD去除率及PTS发生率。

关键词: 静脉置入设备, 静脉导管, 上肢深静脉血栓, 静脉血栓栓塞症, 肿瘤

Abstract: Objective To evaluate the value of regular ultrasound examination in the diagnosis and treatment of deep vein thrombosis associated with central venous access device(CVAD). Methods A total of 440 cancer patients with CAVD treated in Harrsion International Peace Hospital during May 2018 and Sep. 2019 were randomly divided into the observation group(n=221)and observation group(n=219). The observation group received ultrasound examination every 3 weeks to detect the presence of CVAD-related deep venous thrombosis(CRDVT), while the control group received ultrasound examination when clinical symptoms appeared. The patients with CRDVT diagnosed in the two groups were evaluated with ultrasound for no less than 90 days until CVAD was removed, and the thrombosis recurrence during this period was recorded. The diagnostic rate of CRDVT, rate of unplanned CVAD removal, rate of thrombosis recurrence and incidence of post thrombotic syndrome(PTS)were compared between the two groups. Results There was no significant difference in the basic data between the two groups(P>0.05). The diagnostic rate of CRDVT was 9.5%(21 cases)in the observation group and 4.6%(10 cases)in the control group(χ2=4.092, P=0.043). The rate of unplanned CVAD removal was 0.9%(2 cases)in the observation group and 4.1%(9 cases)in the control group(χ2=4.634, P=0.031). The cumulative thrombosis recurrence rate of CRDVT patients in 90 days was 15.3% in the observation group and 10.0% in the control group(Logrank=0.003, P=0.953). The incidence of PTS was 4.7% in the observation group and 40% in the control group(χ2=3.886, P=0.049). Conclusion Regular ultrasonic examination can improve the diagnostic rate of CRDVT and reduce the rate of unplanned CVAD removal and PTS incidence.

Key words: Vascular access devices, Catheters, Upper extremity deep vein thrombosis, Venous thrombosis, Neoplasms

中图分类号:

R574

王宁,郭振江,张媛媛,王晶,郭伟,王金荣,崔朝勃. 定期超声检查在中心静脉置入设备相关深静脉血栓诊治中的应用价值[J]. 山东大学学报 (医学版), 2021, 59(7): 63-67.

WANG Ning, GUO Zhenjiang, ZHANG Yuanyuan, WANG Jing, GUO Wei, WANG Jinrong, CUI Zhaobo. Value of regular ultrasound examination in the diagnosis and treatment of deep venous thrombosis associated with central venous access device[J]. Journal of Shandong University (Health Sciences), 2021, 59(7): 63-67.

参考文献

[1] Zhou X, Lin X, Shen R, et al. A retrospective analysis of risk factors associated with catheter-related thrombosis: a single-center study [J]. Perfusion, 2020, 35(8): 806-813.
[2] 李慧妍, 邵群, 张志仁. 导管相关性血栓研究进展[J]. 肿瘤综合治疗电子杂志, 2019, 5(3): 8-12. LI Huiyan, SHAO Qun, ZHANG Zhiren. Progress of catheter-related thrombosis [J]. Journal of Multidisciplinary Cancer Management(Electronic Version), 2019, 5(3): 8-12.
[3] Taxbro K, Hammarskjöld F, Thelin B, et al. Clinical impact of peripherally inserted central catheters vs implanted port catheters in patients with cancer: an open-label, randomised, two-centre trial [J]. Br J Anaesth, 2019, 122(6): 734-741.
[4] Wang G, Li Y, Wu C, et al. The clinical features and related factors of PICC-related upper extremity asymptomatic venous thrombosis in cancer patients: a prospective study [J]. Medicine(Baltimore), 2020, 99(12): e19409.
[5] Rajasekhar A, Streiff MB. How I treat central venous access device-related upper extremity deep vein thrombosis [J]. Blood, 2017, 129(20): 2727-2736.
[6] Baumann Kreuziger L, Onwuemene O, Kolesar E, et al. Systematic review of anticoagulant treatment of catheter-related thrombosis [J]. Thromb Res, 2015, 136(6): 1103-1109.
[7] Streiff MB, Holmstrom B, Ashrani A, et al. Cancer-associated venous thromboembolic disease, version 1.2015 [J]. J Natl Compr Canc Netw, 2015, 13(9): 1079-1095.
[8] Sousa B, Furlanetto J, Hutka M, et al. Central venous access in oncology: ESMO Clinical Practice Guidelines [J]. Ann Oncol, 2015, 26(Suppl 5): 152-168.
[9] Kearon C, Akl EA, Ornelas J, et al. Antithrombotic therapy for VTE disease: CHEST guideline and expert panel report [J]. Chest, 2016, 149(2): 315-352.
[10] Hrdy O, Strazevska E, Suk P, et al. Central venous catheter-related thrombosis in intensive care patients-incidence and risk factors: a prospective observational study [J]. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub, 2017, 161(4): 369-373.
[11] Kahn SR, Elman EA, Bornais C, et al. Post-thrombotic syndrome, functional disability and quality of life after upper extremity deep venous thrombosis in adults [J]. Thromb Haemost, 2005, 93(3): 499-502.
[12] 王丽丽, 王金荣, 高攀, 等. 中心静脉置入设备相关上肢深静脉血栓形成的诊断、预防和治疗[J]. 中国呼吸与危重监护杂志, 2018, 17(5): 532-538. WANG Lili, WANG Jinrong, GAO Pan,et al.Diagnosis, prevention, and treatment of upper extremity deep vein thrombosis related to central venous placement devices [J]. Chinese Journal of Respiratory and Critical Care Medicine, 2018, 17(5): 532-538.
[13] Rajasekhar A, Streiff MB. Etiology and management of upper-extremity catheter-related thrombosis in cancer patients [J]. Cancer Treat Res, 2019, 179: 117-137. doi: 10.1007/978-3-030-20315-3_8.
[14] Rajasekhar A, Streiff MB. Etiology and management of upper-extremity catheter-related thrombosis in cancer patients [J]. Cancer Treat Res, 2019, 179: 117-137. doi: 10.1007/978-3-030-20315-3_8.
[15] Grant JD, Stevens SM, Woller SC, et al. Diagnosis and management of upper extremity deep-vein thrombosis in adults [J]. Thromb Haemost, 2012, 108(6): 1097-1108.
[16] Verso M, Agnelli G. Venous thromboembolism associated with long-term use of central venous catheters in cancer patients [J]. J Clin Oncol, 2003, 21(19): 3665-3675.
[17] Lee AYY, Kamphuisen PW. Epidemiology and prevention of catheter-related thrombosis in patients with cancer [J]. J Thromb Haemost, 2012, 10(8): 1491-1499.
[18] Thiyagarajah K, Ellingwood L, Endres K, et al. Post-thrombotic syndrome and recurrent thromboembolism in patients with upper extremity deep vein thrombosis: a systematic review and meta-analysis [J]. Thromb Res, 2019, 174: 34-39. doi: 10.1016/j.thromres.2018.12.012.
[19] Laube ES, Mantha S, Samedy P, et al. Treatment of central venous catheter-associated deep venous thrombosis in cancer patients with rivaroxaban [J]. Am J Hematol, 2017, 92(1): E9-E10.
[20] Davies GA, Lazo-Langner A, Gandara E, et al. A prospective study of Rivaroxaban for central venous catheter associated upper extremity deep vein thrombosis in cancer patients(Catheter 2)[J]. Thromb Res, 2018, 162: 88-92. doi: 10.1016/j.thromres.2017.04.003.
[21] Kovacs MJ, Kahn SR, Rodger M, et al. A pilot study of central venous catheter survival in cancer patients using low-molecular-weight heparin(dalteparin)and warfarin without catheter removal for the treatment of upper extremity deep vein thrombosis(The Catheter Study)[J]. J Thromb Haemost, 2007, 5(8): 1650-1653.
[22] Gaddh M, Antun A, Yamada K, et al. Venous access catheter-related thrombosis in patients with cancer [J]. Leuk Lymphoma, 2014, 55(3): 501-508.
[23] Kahn SR, Partsch H, Vedantham S, et al. Definition of post-thrombotic syndrome of the leg for use in clinical investigations: a recommendation for standardization [J]. J Thromb Haemost, 2009, 7(5): 879-883.
[24] Prandoni P, Bernardi E, Marchiori A, et al. The long term clinical course of acute deep vein thrombosis of the arm: prospective cohort study [J]. BMJ, 2004, 329(7464): 484-485.
[25] 刘媛芳, 韦巧玲, 黎容清, 等. 肿瘤患者PICC相关性血栓形成危险因素及风险评估研究进展[J]. 中国医药导报, 2020, 17(28): 52-55. LIU Yuanfang, WEI Qiaoling, LI Rongqing, et al. Research progress on risk factors and assessment of PICC related thrombosis in tumour patients [J]. China Medical Herald, 2020, 17(28): 52-55.

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