- 期刊
- OpenAccess
Infected Right Atrial Thrombus in Hemodialysis Patients-Two Case Reports and a Literature Review
血液透析病患之感染性右心房血栓－兩病例報告暨文獻回顧
摘要
部分的末期腎病息者，仍需藉由中央靜脈導管來接受血液透析治療，而感染性右心房血栓是其中一個少見但嚴重的併發症。我們提出兩個感染性右心房血栓的病例報告，都是藉由中央靜脈導管接受血液透析治療的病患，皆併發methicillin抗藥性金黃色葡萄球菌敗血症與肺血管血栓栓塞。根據我們的案例與文獻回顧，血液透析導管相關的感染性右心房血栓，有可能於放置導管後很短的時間內就發生，其診斷需要依靠臨床醫師高度的警覺心以及完整的影像學檢查，而感染的病原菌大多是葡萄球菌屬；主要的併發症包括有敗血症，轉移性感染，與肺血管血栓栓塞；治療的方式仍有爭議，我們建議立即拔除相關的導管，選用適當的抗生素，並且對於沒有禁忌症的病患給予抗凝血治療；如果血栓大於3公分，則需考慮進行血栓清除手術。
並列摘要
Some patients with end-stage renal disease rely on central catheters for hemodialysis because other options for vascular access cannot be successfully achieved or maintained. We describe two hemodialysis patients with infected right atrial thrombi (RAT), a rare but serious complication related to central catheters, whose courses were both complicated with methicillin resistant Staphylococcus aureus septicemia and pulmonary thrombo embolism. In addition, we reviewed the literature for catheter-associated RAT, specifically in hemodialysis patients with documented infections. Our cases and the review illustrate that this complication may appear within a relatively short period of time after catheter placement. The diagnosis warrants that physicians maintain a high degree of suspicion and undertake comprehensive imaging studies. The most common pathogen is Staphylococcus species. Major complications include sepsis, metastatic infection, and pulmonary thromboembolism. The optimal treatment of infected RAT remains controversial. According to our cases and review, we suggest immediate catheter removal, proper antimicrobials, and anticoagulants if not contraindicated. In patients with a large thrombus size (over 3 cm), surgical thrombectomy should be considered.