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脉静脉导管治疗与患有神经瘤下arachnoid 出血的患者的并发症增加无关

Feras Akbik¹, Yuyang Shi², Steven Philips¹

¹Division of Neurocritical Care, Department of Neurology and Neurosurgery, Emory University School of Medicine, 1364 Clifton Rd NE, Atlanta, GA, 30322, USA.

Neurocritical care

|November 26, 2024

概括

内中枢静脉导管 (CVC) 在神经关键护理患者与动脉瘤下arachnoid出血 (aSAH) 不增加内压力 (ICP). 这项研究发现,内通道的进入是安全的,并且与其他部位相比,并发症较少.

科学领域:

神经外科神经外科
关键护理医学关键护理医学
血管接入血管接入

背景情况:

传统的神经临床护理指南建议不要进行内 (IJ) 中枢静脉导管 (CVC) 导管,因为可能会增加内压力 (ICP) 的风险.
有限的经验数据存在,以验证这种长期存在的假设.
动脉瘤下关节出血 (aSAH) 经常导致大脑,需要侵入性ICP监测,通常通过外部心室排水 (EVDs).

研究的目的:

调查aSAH患者的CVC访问站点和ICP测量之间的关系.
根据CVC插入部位来评估导管相关并发症的发生率.
挑战或证实关于神经临床护理中IJ接入的经典教学.

主要方法:

这是一项对1577名在2012年至2020年期间入院的aSAH患者进行的回顾性队列研究.
根据初始的CVC接入部位对患者进行分类:关节下 (SC),IJ,大腿部或外围插入的中央导管 (PICC).
分析了1220名患有EVD的患者的ICP数据,使用线性混合效应模型,比较IJ与非IJ接入.

主要成果:

关节下关节进入最常见 (56.2%),其次是内关节 (23.1%).
创伤性肺胸部显著高于SC接入 (3.0%). 腿部和PICC线路显示较高的深静脉血栓症率.
在插入后的24小时和10天内,ICP测量在IJ和非IJCVC组之间没有显著差异.

结论:

与既定的教条相反,在aSAH患者中IJ CVC安置与增加的ICP无关.
与SC,大腿骨和PICC相比,IJ接入显示出最低的接入部位并发症率.
超声导向的IJ静脉导管被这些数据支持为神经关键病患者的安全和潜在的首选方法.

关键词:

动脉瘤是一个动脉瘤.中心静脉导管治疗内压力内压力甲状腺下下垂体出血

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