- 期刊
Dalteparin for Severe Central Venous Catheter-Related Thrombosis in an Adult with Septic Shock: A Successful Treatment Experience
在一敗血症成年病人使用Dalteparin治療中央靜脈導管引起的嚴重血栓併發症：病例報告
摘要
中央靜脈導管造成的中央靜脈血栓是一個被低估的併發症。相較於血液腫瘤科、小兒科、和洗腎病人等，在敗血症病人這一部分，只有非常少的文獻討論放置中央靜脈導管後的血栓併發症。敗血症對於全身凝血會有影響，不只和上述疾病的機制不一樣，並且會促成血栓的形成。造成中央靜脈阻塞的嚴重中央靜脈導管血栓併發症是相當罕見的，傳統如warfarin和血栓溶解劑以及新一代的recombinant human activated protein C用於敗血症病人的安全性未明，故目前仍無確定的治療準則。隨著敗血症發生率上升和廣泛使用中央靜脈導管，中央靜脈導管血栓症值得多加注意和討論。本文報告一個罹患敗血症的成人於股靜脈處放置中央靜脈導管後出現嚴重的股靜脈血栓，使用下肢duplex超音波確定診斷後，在採用皮下注射dalteparin治療病人七天之後血管內血栓完全消除。本病例經驗指出，使用dalteparin治療中央靜脈導管血栓併發症是安全、方便、以及經濟有效的。
並列摘要
Central venous thrombosis after central venous catheter indwelling is an underestimated complication. There are far fewer reports on the clinical significance of catheter-related thrombosis in septic adults, than in hemato-oncologic, pediatric, and hemodialytic patients. Sepsis has impacts on the systemic coagulation mechanism that differ from the above diseases, and potentiates thrombosis formation. Severe catheter-related thrombosis manifesting as central venous occlusion is very rare. The safety of warfarin, thrombolytic agents, and recombinant human activated protein C in septic patients remains unclear; therefore, the treatment of choice is not well established. With the increased sepsis incidence and widespread use of central venous catheters in these patients, catheter-related thrombosis should be given more attention and discussion. We report a septic shock patient with severe femoral venous thrombosis after central venous catheter implantation. A lower extremity duplex ultrasonogram confirmed the diagnosis. The patient was treated with dalteparin subcutaneously. The endovascular thrombosis resolved completely 7 days later. This treatment experience suggests that dalteparin is safe and cost-effective for catheter-related thrombosis.
延伸閱讀
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