导管相关性上肢静脉血栓形成的诊治

摘要

目的:分析探讨静脉置管导致上肢静脉血栓形成的原因及治疗方法.方法:回顾性分析16例静脉导管相关上肢静脉血栓患者的临床资料并进行随访.其中7例患者为术后静脉营养,9例患者为晚期肿瘤化疗或静脉营养.结果:16例患者住院时间9～18d,平均12 d,7例经股静脉入路行上腔静脉滤器植入术.出院时患肢肿胀完全消失11例,明显减轻5例.随访6～24个月,2例死于晚期肿瘤,余患者无肺栓塞表现,复查胸片未见滤器形态、位置异常.结论:导管相关上肢静脉血栓的病因是多因素的,抗凝是主要治疗措施,上腔静脉滤器置入是可行的,可有效预防肺栓塞.%Objective: To explore the etiology and treatment of catheter related venous thrombosis in upper extremities.Methods: Retrospective analysis of 16 cases of catheter related venous thrombosis in upper extremities hospitalized in vascular surgery department of Provincial Hospital affiliated to Shandong University from January 2003 to October 2010, including 7 cases of parenteral nutrition after operation, 9 cases with advanced tumors which underwent chemotherapy or parenteral nutrition.Results: Sixteen patients were in hospital for 9～18 days (mean 12 days).Seven patients underment superior vena cava filter placement through femoral vein.Swelling in upper extremities vanished completely in 11 cases and relieved obviously in 5 cases.All cases were followed up for 6 to 24 months.Two patients died of advanced tumor.No pulmonary embolism was found in the rest patients.No configuration and position abnormality was found in superior vene cave filter with chest radiograph.Conclusions: Catheter related venous thrombosis in upper extremities is a disease with multiple etiologies and the key is prevention The primary treatment is anticoagulation, and superior vena cava filter placement can prevent pulmonary embolism effectively.