摘要
导管相关性静脉血栓(CRT)的处理包括血栓的预防和治疗,两者缺一不可。预防策略又包括置管前危险因素的分析和准备如选择合理的导管规格和置管部位能减少CRT的发生;置管术中减少血栓发生的危险因素如无菌操作,导管头端放置于上腔静脉心房入口处;置管后血栓发生的预防措施如功能锻炼,不建议常规预防抗凝治疗。一旦发生了血栓,排除抗凝禁忌证后尽快开始抗凝治疗,抗凝时间至导管拔除后3个月;不建议放置上腔静脉滤器,不建议导管溶栓。尽可能保留有功能的导管,直到导管失功或者不再需要导管。至于拔管时机,建议在抗凝治疗2周后,分次拔出,以减少血栓脱落肺栓塞的风险。
The treatment of catheter-related venous thrombosis includes the prevention and treatment of thrombosis,and both of them are indispensable.Prevention strategies include the analysis and preparation of risk factors before catheterization preparation,such as the selection of best catheter type and catheter position,can reduce the occurrence of CRT.During catheterization,aseptic operation,the tip of the catheter is placed at the entrance of the superior vena cava atrium will all contribute to reduce the risk of thrombosis.Post-catheterization rules like functional exercise are also useful preventive measurest.Routine anticoagulation therapy is not recommended.Once thrombosis occurs,anticoagulation treatment should start as soon as possible only after contraindication is eliminated.Anticoagulation time would last to 3 months after catheter removal.Superior vena cava filter and thrombolysis are not recommended.Keep a functional catheter as long as possible until the catheter is no longer needed or disfunctional.It is recommended to remove the catheter after 2 weeks of anticoagulant therapy step by step instead of once for fear of the risk of pulmonary embolism.
作者
郭相江
张岚
GUO Xiang-jiang;ZHANG Lan(Department of Vascular Surgery,Renji Hospital,School of Medicine,Shanghai Jiaotong University,Shanghai 200127,China)
出处
《中国实用外科杂志》
CAS
CSCD
北大核心
2021年第12期1352-1356,共5页
Chinese Journal of Practical Surgery
基金
上海交通大学“科技创新专项资金”多学科交叉项目培育(转化)(No.YG2019ZDA12)。
关键词
导管相关性血栓
处理原则
catheter related venous thrombosis
management principals
