中心静脉穿刺置管的合并症.ppt

                                                                                                                                                                                                           中心静脉穿刺置管并中心静脉穿刺置管并发症发症山东省立医院麻醉科高淑文                                                                                     一、穿刺置管并发症                                                                                                                                                                                                           气胸锁骨下静脉或低位颈内静脉穿刺给并发症                                                                                                                                                                                                            导管误入动脉一般情况下造成血肿大口径导管可造成动脉损伤，需手术处理                                                                                                                                                                                                           胸导管损伤 ØØ左侧锁骨下静脉穿刺置管中出现左侧锁骨下静脉穿刺置管中出现 ØØ胸导管损伤或破裂胸导管损伤或破裂 －乳糜胸－乳糜胸ØØ导管误入，可出现潜在的纵隔灌注或乳糜胸导管误入，可出现潜在的纵隔灌注或乳糜胸2 2种结果种结果                                                                                                                                                                                                           上腔静脉综合症伴乳糜胸                                                                                                                                                                                                            上腔静脉梗阻伴食道静脉曲张                                                                                                                                                                                                            纵隔血肿                                                                                                                                                                                                            心包填塞                                                                                                                                                                                                            传导阻滞                                                                                                                                                                                                            急性呼吸窘迫综合症                                                                                                                                                                                                            长期留管并发症                                                                                                                                                                                                            浙江大学报道 ØØ2001.1.～2003.3.六个月ØØ一共111条血透双腔导管                                                                                                                                                                                                           损伤性并发症ØØ血肿的发生率为8.1％（9/111），ØØ导管位置不正的发生率为4.5％，ØØ没有血胸、气胸、空气栓塞、静脉破裂等并发症发生。

                                                                                                                                                                                                           感染Ø6例导管相关性感染（5.4％）Ø2例细菌性感染被治愈Ø4例为真菌性感染，其中1例被治愈，另3例不能控制的感染而被迫拔出导管                                                                                                                                                                                                           血栓性并发症导管血栓的发生率为18.9％(21/111)，从放置导管到血栓形成的平均时间为36天（6-725天）                                                                                                                                                                                                           周围静脉置管的并发症ØØ来自新加坡的急诊医院的回顾性报道来自新加坡的急诊医院的回顾性报道ØØ2002.7.2002.7.～～10. ,7810. ,78人人9494条中心导管条中心导管ØØ导管存留平均导管存留平均17.217.2天天 ，，ØØ3333条条(35.1%)(35.1%)因出现并发症而被拔除，主要并发症是因出现并发症而被拔除，主要并发症是静脉炎静脉炎 ØØ结论：经周围静脉放中心静脉导管安全可靠，并发结论：经周围静脉放中心静脉导管安全可靠，并发症较轻微症较轻微                                                                                                                                                                                                            血栓形成和栓塞                                                                                                                                                                                                            上肢深静脉血栓                                                                                                                                                                                                            右心房血栓                                                                                                                                                                                                           空气栓塞                                                                                                                                                                                                            三、罕见并发症                                                                                                                                                                                                            导管远端移位造成急性喉麻痹                                                                                                                                                                                                            小儿中心静脉置管中的颅内并发症                                                                                                                                                                                                           早产儿周围静脉置管后罕见并发症                                                                                                                                                                                                            周围静脉置管后前臂骨间神经综合症                                                                                                                                                                                                            导管折断                                                                                                                                                                                                           四、诊断及处理                                                                                                                                                                                                            ØØ1.介入放射学技术在中心静脉导管功能不良诊断中的作用                                                                                                                                                                                                            2.常规超声引导中心静脉穿刺置管的意义                                                                                                                                                                                                            儿童静脉血栓诊断 ØØ磁共振结合静脉造影诊断上下腔静脉系统血栓ØØ磁共振结合肺血管造影有助于诊断肺栓塞                                                                                                                                                                                                           国内预防和处理血栓方法。