Incidence And Risk Factors Of Centarl Venous Catheter-related Thrombosis After The Esophageal Cancer Surgery

Research ObjectivesTo observe and count the occurrence of central venous catheter-related(CVC-related)thrombosis after the esophageal cancer surgery,and to explore the related risk factors for its formation,so as to provide reliable clinical basis for active prevention and treatment in clinical work,in order to prevent high-risk groups in perioperative period.Materials and MethodsThe clinical data of 230 patients with esophageal cancer after CVC implantation in Department of Thoracic Surgery,Second Affiliated Hospital of Zhengzhou University from January 2018 to October 2020 were collected for retrospective case-control study.The general information of patients was recorded by complete electronic medical records,including age,gender,body mass index(BMI),smoking history,drinking history,hypertension history,diabetes history,surgical mode(minimally invasive/thoracotomy),TNM staging,tumor histological type,and perioperative blood transfusion,and catheter data,including the number of puncture,catheter type,puncture site(right internal carotid/right subclavian vein),catheter indwelling time.The laboratory examination data included preoperative and postoperative platelet cell count(PLT),fibrinogen(Fbg),D-dimer(DD),high density lipoprotein cholesterol(HDL-C),and low density lipoprotein cholesterol(LDL-C).Ultrasound examination and extubation were performed to observe whether there was thrombosis at the tip or inside the catheter.It was found that thrombosis was included in the thrombosis group,and no thrombosis was found in the non-thrombosis group.The SPSS 26.0 was used for statistical analysis.Measurement data were expressed by“mean±standard deviation”(x±s),and t test was used for comparison between groups.Count data was expressed as rate(%),andx~2test was used for comparison between groups.Multivariate analysis adopted the logistic regression model of binary classification results variables to analyze the risk factors of postoperative esophageal cancer complicated with CVC-related thrombosis.All statistical tests were bilateral tests,and the difference was statistically significant(P<0.05).Results(1)128 cases of CVC-related thrombosis were clearly included by ultrasound examination and extubation,and the incidence was as high as55.65%.However,only 9 cases had obvious clinical symptoms,and the incidence of symptomatic catheter-related thrombosis was 3.91%.No central venous extubation accident syndrome occurred in all the included subjects during extubation.(2)Univariate analysis showed that age≥65 years old,history of diabetes mellitus,perioperative blood transfusion,catheter indwelling time,puncture times,postoperative Fbg and postoperative DD were associated with CVC-related thrombosis,and the differences were statistically significant(all P14d(OR=2.708,95%CI:1.257～5.832),postoperative Fbg level(OR=1.539,95%CI:1.222～1.939)and postoperative DD level(OR=1.161,95%CI:1.036～1.301)were independent risk factors for CVC-related thrombosis after esophagectomy.Conclusions(1)The incidence of CVC-related thrombosis after esophageal cancer surgery is high,which should be paid enough attention to by medical workers in clinic.However,the incidence of symptomatic catheter-related thrombosis is not high,and there is no increasing trend in the incidence of serious complications.(2)CVC-related thrombosis after esophageal cancer surgery is the result of interaction of multiple factors.Advanced age(≥65 years),history of diabetes,perioperative blood transfusion,catheter indwelling time>14days,postoperative Fbg and postoperative DD levels were independent risk factors for CVC-related thrombosis after the esophageal cancer surgery.