Spectrum of upper-extremity deep venous thrombosis in a community teaching hospital.
Spectrum of upper-extremity deep venous thrombosis in a community teaching hospital.
复制标题
社区教学医院上肢深静脉血栓形成谱。
DOI：
10.1067/mhl.2000.105758
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发表时间：
2000
期刊：
影响因子：
--
通讯作者：
R. Markert
中科院分区：
文献类型：
--
作者：
M. Marinella;S. Kathula;R. Markert
目标
本研究的目的是描述社区教学医院上肢深静脉血栓形成的谱系特征。
设计与设置
对一家大型城市教学医院进行了回顾性分析。
材料和方法
我们回顾了 90 名超声记录的颈内静脉、锁骨下静脉、腋静脉或臂静脉血栓患者的记录，以确定临床特征、危险因素和结果。
结果
与上肢深静脉血栓形成相关的最常见的基础疾病是 65 例患者 (72%) 存在中心静脉导管、25 例患者 (28%) 存在感染、20 例患者 (22%) 患有胸外恶性肿瘤、19 例患者 (21%) 患有胸腔恶性肿瘤、19 例患者 (21%) 患有肾功能衰竭、16 例患者既往有下肢深静脉血栓形成(18%)。 31 名患者 (34%) 出现疼痛，76 名患者 (84%) 出现受累肢体水肿。 44例（49%）患者累及左锁骨下静脉，35例患者（39%）左锁骨下静脉有中心静脉导管。当存在中心静脉导管时，深静脉血栓通常发生在同侧（P <.001）。分别有 65 名 (72%) 和 53 名 (59%) 患者服用了肝素和华法林。 11 名患者（12%）死亡。在这些患者中，8 名 (73%) 存在潜在感染，而只有 22% 的幸存者存在感染 (P =.0012)。
结论
上肢深静脉血栓形成通常发生在存在中心静脉导管的全身性疾病患者中。左锁骨下静脉经常受累，因为这是放置中心静脉导管的常见部位。疼痛并不常见，但大多数患者会出现受累肢体水肿。本研究中上肢深静脉血栓患者的死亡率为12%；大多数死亡患者有中心静脉导管和潜在感染。
OBJECTIVE
The goal of this study was to characterize the spectrum of upper-extremity deep venous thrombosis in a community teaching hospital.
DESIGN AND SETTING
A retrospective analysis was used at a large urban teaching hospital.
MATERIAL AND METHODS
We reviewed the records of 90 patients with ultrasound-documented thrombosis of the internal jugular, subclavian, axillary, or brachial veins to determine clinical characteristics, risk factors, and outcome.
RESULTS
The most common underlying conditions associated with upper-extremity deep venous thrombosis were the presence of a central venous catheter in 65 patients (72%), infection in 25 (28%), extrathoracic malignancy in 20 (22%), thoracic malignancy in 19 (21%), renal failure in 19 (21%), and a prior lower-extremity deep venous thrombosis in 16 (18%). Pain was noted in 31 (34%) patients, and 76 patients (84%) had edema of the involved extremity. The left subclavian vein was involved in 44 patients (49%), and 35 patients (39%) had a central venous catheter in the left subclavian vein. When a central venous catheter was present, the deep venous thrombosis was usually ipsilateral (P <.001). Heparin and warfarin were administered to 65 (72%) and 53 (59%) of the patients, respectively. Eleven patients (12%) died. Of these patients, 8 (73%) had an underlying infection, whereas only 22% of survivors had an infection (P =.0012).
CONCLUSION
Upper-extremity deep venous thrombosis typically occurs in patients with a systemic illness in the presence of a central venous catheter. The left subclavian vein is frequently involved because this is a common site for placement of a central venous catheter. Pain is uncommon, but edema of the involved extremity is noted in the majority of patients. The mortality rate of patients in this study with an upper-extremity deep venous thrombosis was 12%; most patients who died had a central venous catheter and an underlying infection.