血液肿瘤患者PICC置入部位医用粘胶相关性皮肤损伤的多因素分析  

Medical adhesive-related skin injury associated factors at PICC insertion site in patients with hematologic malignancies

作　　者：赵慧函 黄惠桥[1] 韦琴[1] 周雪梅[2] 凌瑛[3] 李高叶[1] 应燕萍[1] Zhao Huihan Huang Huiqiao IVei Qin Zhou Xuemei Ling Ying Li C.aoye Ying Yanping(Nursing Department, the First Affiliated Hospital of Guangxi Medical University, Nanning 530021, China)

机构地区：[1]广西医科大学第一附属医院护理部,南宁530021 [2]广西医科大学第一附属医院血液内科,南宁530021 [3]广西医科大学第一附属医院肿瘤内科,南宁530021

出　　处：《中国实用护理杂志》2017年第5期335-340,共6页Chinese Journal of Practical Nursing

基　　金：基金项目：广西医疗卫生适宜技术研究与开发项目（S201524）;广西医药卫生自筹经费计划课题项目（Z2016342）

摘　　要：目的 了解血液肿瘤患者PICC置入部位医用粘胶相关性皮肤损伤（MARSI）的流行情况并分析其相关因素.方法 持续2周的横断面观察性研究在广西医科大学第一附属医院血液内科开展,同一研究者在PICC维护过程采集局部皮肤信息及皮肤图片,其他相关信息通过电子病历系统收集.皮肤科医生及PICC专科护士共同对皮肤损伤进行分类.统计MARSI的流行情况,同时分析其相关因素,明确独立危险因素.结果 总共纳入153例研究对象.MARSI的总发生率为33.99%（52/153）,分别包括：机械性皮肤损伤22.87%（35/153）、接触性皮炎（CD）9.80%（15/153）、潮湿相关性皮肤损伤0.65%（1/153）、毛囊炎0.65%（1/153）.多因素分析发现年龄≥50岁（P=0.016,OR=5.919,95%CI 1.389~25.220）、非PICC专科护士维护（P=0.013,OR=8.333,95%CI 1.566~44.360）为机械性皮肤损伤的独立危险因素.皮肤过敏史（P=0.000,OR=12.333,95%CI 3.669~41.454）、经PICC输注三氧化二砷（P=0.003,OR=4.565,95%CI 1.661~12.547）为CD的独立危险因素.结论 血液肿瘤患者PICC置入部位MARSI发生率较高,本研究分析了流行病学数据及独立危险因素,为此领域今后的研究提供了基础.Objective To measure the prevalence and analyzed associated factors of medical adhesive-related skin injuries （MARSI） at PICC insertion site in patients with hematologic malignancies. Methods A cross- sectional observational study lasting two weeks was carried out in Department of Hematology. Skin assessment data and photographs of skin were collected during PICC maintenances by the same investigator. The related information was got out from the medical record. The observed skin injuries were classified by the dermatologist and PICC specialized nurse together. MARSI prevalence was calculated. The associated factors were analyzed statistically. Results All of the 153 patients with hematologic malignancies were included. The prevalence of total MARSI at PICC insertion site was 33.99%（52/153）, including mechanical skin injury （22.87%,35/153）, contact dermatitis （CD） （ 9.80%,15/153）, moisture-associated skin damage （0.65%,1/153）, folliculitis（0.65%,1/153）, respectively. Multivariate analysis identified two independent risk factors for mechanical skin injury including age≥50 years old, P=0.016, odds ratio （OR）=5.919, 95%CI 1.389-25.220 and non-specialist nurses in PICC maintenance, P=0.013, OR=8.333,95%CI 1.566-44.360. History of skin allergies （P=0.000,OR=12.333,95%CI 3.669-41.454） and arsenic trioxide infusion through PICC（P=0.003,OR=4.565,95%CI 1.661-12.547） were associated with CD. Conclusions MARSI at PICC insertion site is a prevalent event in the patients with hematologic malignancies. Epidemiological data and independent risk factors are presented in our study, which provide a basis for future study in this area.

关 键 词：血液肿瘤 导管插入术 中心静脉 流行病学 因素分析 统计学 皮肤损伤 

分 类 号：R473.73[医药卫生—护理学]