本周四nejm推送的来自法国的一项多中心（成人ICU）包含近3500例的中心静脉置管rct研究表明，锁骨下途径造成的血源性感染和dvt（有症状）最低，最高的是股静脉，其次是颈静脉。从风险上来说，股静脉发生血源性感染和dvt（有症状）的风险是锁骨下的3.5倍，颈静脉是锁骨下的2.1倍。
从气胸上来说，锁骨下发生气胸最高，其次是颈静脉。(Funded by the Hospital Program for Clinical Research, French Ministry of Health; ClinicalTrials.gov number, NCT01479153.
September 24, 2015N Engl J Med 2015; 373:1220-1229HideAbstract / Article ExtractBackgroundThree anatomical sites are commonly used to insert central venous catheters, but insertion at each site has the potential for major complications.MethodsIn this multicenter trial, we randomly assigned nontunneled central venous catheterization in patients in the adult intensive care unit (ICU) to the subclavian, jugular, or femoral vein (in a 1:1:1 ratio if all three insertion sites were suitable [three-choice scheme] and in a 1:1 ratio if two sites were suitable [two-choice scheme]). The primary outcome measure was a composite of catheter-related bloodstream infection and symptomatic deep-vein thrombosis.ResultsA total of 3471 catheters were inserted in 3027 patients. In the three-choice comparison, there were 8, 20, and 22 primary outcome events in the subclavian, jugular, and femoral groups, respectively (1.5, 3.6, and 4.6 per 1000 catheter-days; P=0.02). In pairwise comparisons, the risk of the primary outcome was significantly higher in the femoral group than in the subclavian group (hazard ratio, 3.5; 95% confidence interval [CI], 1.5 to 7.8; P=0.003) and in the jugular group than in the subclavian group (hazard ratio, 2.1; 95% CI, 1.0 to 4.3; P=0.04), whereas the risk in the femoral group was similar to that in the jugular group (hazard ratio, 1.3; 95% CI, 0.8 to 2.1; P=0.30). In the three-choice comparison, pneumothorax requiring chest-tube insertion occurred in association with 13 (1.5%) of the subclavian-vein insertions and 4 (0.5%) of the jugular-vein insertions.ConclusionsIn this trial, subclavian-vein catheterization was associated with a lower risk of bloodstream infection and symptomatic thrombosis and a higher risk of pneumothorax than jugular-vein or femoral-vein catheterization.（急诊医学资讯）
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发表于 2015-9-28 12:50:50
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