Clinical application of subclavian catheterization in severe hepatitis: a clinical analysis of 506 cases
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摘要:
目的总结重型肝炎患者行锁骨下静脉穿刺置管术期间的并发症,探讨其安全性和处理方法。方法对桂林市第三人民医院2001年10月-2012年12月期间506例重型肝炎患者做双重血浆置换联合胆红素吸附(DPMAS)等非生物型人工肝手术前进行锁骨下静脉穿刺置管,严密观察记录术中、术后各种不良反应。结果本组穿刺成功492例(97.2%),发生相关并发症38例(7.5%),其中穿刺点局部血肿/出血不止15例,导管感染13例,误入锁骨下动脉10例。结论锁骨下静脉穿刺术穿刺成功率高,可充分保障临床抢救与治疗需要,多数并发症经对症处理后不影响治疗。锁骨下静脉穿刺置管术可安全地应用于有凝血机制障碍的重型肝炎患者。
Abstract:Objective To summarize the complications of subclavian catheterization in severe hepatitis patients and to investigate clinical safety and treatment. Methods Five hundred and six cases of severe hepatitis, who underwent subclavian catheterization before non- bioartificial liver operation like double plasma molecular adsorption system, were enrolled. Intraoperative and postoperative adverse reactions were under close observation and recording. Results Of all patients, 492 (97. 2%) were punctured and catheterized successfully, and 38 (7.5%) developed complications, including local hematoma and bleeding at puncture sites (15 cases) , catheter infection (13 cases) , and catheterization into the subclavian artery (10 cases) . Conclusion Subclavian catheterization has a high success rate, and is sufficient to meet the need of clinical rescue and treatment. Most complications would not interfere with treatment outcome after proper disposal. Subclavian catheterization can be safely applied to severe hepatitis patients with coagulation disturbance.
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[1]LIU XH, GUO HQ, ZHANG J, et al.Progress in technology and clinical application of non-bioartificial liver support system[J].J Clin Hepatol, 2013, 29 (9) :661-665. (in Chinese) 刘晓慧, 郭海清, 张晶, 等.非生物型人工肝技术及其临床应用新进展[J].临床肝胆病杂志, 2013, 29 (9) :661-665. [2]LIN W, KONG M, GAO YJ, et al.Control study on the immediate effect and adverse reaction of different types of artificial liver treatment of liver failure[J].J Clin Hepatol, 2011, 27 (3) :306-308, 315. (in Chinese) 林伟, 孔明, 高玉娟, 等.不同类型人工肝治疗重型肝病的即刻疗效及不良反应对照[J].临床肝胆病杂志, 2011, 27 (3) :306-308, 315. [3]PODOLL AS, DEGOLOVINE A, FINKEL KW.Liver support systems-a review[J].ASAIO J, 2012, 58 (5) :443-449. [4]LEE K, MUN CH, MIN BG.Development of a multifunctional detoxifying unit for liver failure patients[J].Blood Purif, 2012, 34 (3-4) :225-230. [5]FISHER NC, MUTIMER DJ.Central venous cannulation in patients with liver disease and coagulopathy-a prospective audit[J].Intensive Care Med, 1999, 25 (5) :481-485. [6]TSAI YF, KU YH.Left-subclavian vein port-a-cath systems:comparison of complications[J].Eur Surg Res, 2012, 49 (2) :66-72. [7]ZOU DL, LI Q, LIU QX, et al.The clinical observation of different approaches France subclavian vein puncture[J].J Pract Med, 2005, 21 (5) :506-507. (in Chinese) 邹冬玲, 李泉, 刘琴湘, 等.不同入路法锁骨下静脉穿刺的临床观察[J].实用医学杂志, 2005, 21 (5) :506-507. [8]AYDIN Z, GURSU M, UZUN S, et al.Placement of hemodialysis catheters with a technical, functional, and anatomical viewpoint[J].Int J Nephrol, 2012, 2012:302826. [9]KOSSAIFY A, NICOLAS N, EDDE P.Hemoptysis after subclavian vein puncture for pacemaker implantation:importance of wireguided venous puncture[J].Clin Med Insights Case Rep, 2012, 5 (1) :119-122. [10]AGRAWAL S, PAYAL YS, SHARMA JP.A retrospective clinical audit of 696 central venous catheterizations at a tertiary care teaching hospital in India[J].J Emerg Trauma Shock, 2012, 5 (4) :304-308. [11]LAURENZI L, NATOLI S, BENEDETTI C, et al.Cutaneous bacterial colonization, modalities of chemotherapeutic infusion, and catheter-related bloodstream infection in totally implanted venous access devices[J].Support Care Cancer, 2004, 12 (11) :805-809. [12]ALDRIGHETTI L, PAGANELLI M, ARRU M, et al.Complications of blind placement technique in 980 subcutaneous infusion ports[J].J Vasc Access, 2000, 1 (1) :28-32. [13]KIM JT, OH TY, CHANG WH, et al.Clinical review and analysis of complications of totally implantable venous access devices for chemotherapy[J].Med Oncol, 2012, 29 (2) :1361-1364. [14]KARKEE DV.Subclavian vein dialysis access catheter-complications are low[J].Nepal Med Coll J, 2010, 12 (4) :248-252. [15]RIBEIRO RC, ABIB SC, AGUIAR AS, et al.Long-term complications in totally implantable venous access devices:randomized study comparing subclavian and internal jugular vein puncture[J].Pediatr Blood Cancer, 2012, 58 (2) :274-277. [16]BARBETAKIS N, ASTERIOU C, KLEONTAS A, et al.Totallyimplantable central venous access ports analysis of 700 cases[J].J Surg Oncol, 2011, 104 (6) :654-656. [17]YU HZ.Clinical analysis of368 cases with subclavian vein catheterization[J].Hainan Med J, 2009, 20 (5) :118-120. (in Chinese) 于洪志.锁骨下静脉穿刺置管术368例临床分析[J].海南医学, 2009, 20 (5) :118-120. [18]YAN D, ZHAO CE, FAN H.Application of central venous catheterization:a clinic analysis of 389 cases[J].Chin General Prac, 2009, 12 (11) :1982-1983. (in Chinese) 闫冬, 赵呈恩, 樊宏.中心静脉置管389例临床分析[J].中国全科医学, 2009, 12 (11) :1982-1983. [19]YANG JY, CAO LJ.The complications of 110 cases with severe hepatitis subclavian vein catheterization[J].Acta Med Sinica, 2007, 20 (2) :231-232. (in Chinese) 杨景毅, 曹立军.110例重型肝炎锁骨下静脉穿刺置管的并发症[J].华夏医学, 2007, 20 (2) :231-232. [20]REN PT, RUAN XX, LU BC, et al.The cause of after deep vein catheterization serious complications[J].J Emerg Med, 2006, 15 (9) :856-858. (in Chinese) 任培土, 阮新贤, 鲁葆春, 等.深静脉穿刺置管后严重并发症的原因[J].中华急诊医学杂志, 2006, 15 (9) :856-858. [21]ZHANG X, HE ZJ, ZHAO XD, et al.Study on the method for deep venus puncture[J].Chin J Crite Care Med, 2007, 27 (5) :423-426. (in Chinese) 张宪, 何忠杰, 赵晓东, 等.深静脉穿刺置管的方法研究[J].中国急救医学, 2007, 27 (5) :423-426. [22]YANG JY, CHENG SQ, XIAN YC, et al.Clinical research of plasmapheresis treatment severe hepatitis[J].Clin Focus, 2008, 23 (23) :1713-1714. (in Chinese) 杨景毅, 程书权, 冼永超, 等.血浆置换治疗重型肝炎临床研究[J].临床荟萃, 2008, 23 (23) :1713-1714. [23]FRAGOU M, GRAVVANIS A, DIMITRIOU V, et al.Real-time ultrasound-guided subclavian vein cannulation versus the landmark method in critical care patients:a prospective randomized study[J].Crit Care Med, 2011, 39 (7) :1607-1612.
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