在接受治疗性肝素输液的患者中,无并发症的外周外注切除:一个病例报告
Lizbeth Hu1, Janet Adegboye1, Angela Tung Chang1
1Department of Anesthesiology and Critical Care Medicine, Johns Hopkins Medicine, Baltimore, Maryland, USA.
Regional anesthesia and pain medicine
|May 31, 2024
概括
在接受治疗抗凝剂的患者中,管理外周导管需要仔细评估风险. 这一案例凸显了多学科讨论的必要性,以平衡外周血液瘤风险与血栓形成风险,当必须管理抗凝药时.
科学领域:
- 肝胆道手术 肝胆道手术
- 关键护理医学 关键护理医学
- 麻醉学 麻醉学
- 血液学 血液学 血液学
背景情况:
- 复杂的手术患者可能会经历意想不到的血栓事件,当外周导管被使用手术前.
- 与治疗性抗凝药一起管理外周止痛,带来了重大的临床挑战.
- 平衡外腔内血瘤与血栓性并发症的风险至关重要.
研究的目的:
- 介绍一个胸腔外围导管管理的病例,该病例发生在患有状胆瘤的患者身上,该患者正在接受重大肝脏手术.
- 为了说明在需要高剂量的肝素治疗门静脉血栓症的患者外周导管切除的决策过程.
- 强调复杂的抗凝血药和外围治疗治疗方案中多学科方法的重要性.
主要方法:
- 一名患有 Hilare 胆管癌的患者接受了肝切除术,胆管切除术和肝结合术,并安置胸外导管以缓解疼痛.
- 在术后,患者出现了门静脉血栓形成,需要新兴血栓切除术和高剂量肝素输液.
- 一个多学科的团队召开会议,讨论了除外腔导管切除的选择,同时保持抗凝剂,考虑到外周血液瘤和再血栓形成的风险.
主要成果:
- 患者在术后第一天发生了全门静脉血栓形成,需要用肝素进行激烈的抗凝血治疗.
- 由于再次血栓塞的高风险,决定将肝素输注减少到除外导管去除的最低治疗抗Xa水平.
- 外周导管被移除,患者在ICU中得到监测,没有任何不良事件,包括外周血液瘤或复发性血栓形成.
结论:
- 多学科团队讨论对于在治疗抗凝血治疗的患者中切除外周导管时权衡外周血液瘤与灾难性血栓形成的风险至关重要.
- 个性化风险效益分析对于管理涉及外周止痛和抗凝药的复杂病例至关重要.
- 这一案例强调了需要仔细考虑外周导管切除期间的抗凝管理,以防止严重的并发症.
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