PICC导管/静脉直径比最佳临界值的研究  

Application of ROC curve in optimal cut-off point of PICC catheter/vein diameter ratio

作　　者：宋燕伶 何金爱[1] 刘胤佃 李倩玲[2] 邹晓春[1] 

机构地区：[1]暨南大学附属第一医院护理部,广州市510632 [2]暨南大学附属第一医院导管门诊,广州市510632

出　　处：《中国护理管理》2017年第6期737-742,共6页Chinese Nursing Management

基　　金：广东省科技计划项目(2014A020212218);2016年暨南大学附属第一医院护理科研专项基金(2016403)

摘　　要：目的 :分析PICC置管患者的导管/静脉直径比例(C/V)对产生PICC相关静脉血栓的影响,并探寻C/V的最佳临界值。方法 :对2016年2-9月符合研究标准的患者于置管前、后使用SiteRite 5超声行血管评估,测量置管静脉穿刺口处内径,计算C/V,随访一个月评估血栓发生情况并通过彩超进行证实,对不同C/V血栓发生率进行比较;采用受试者工作特征(ROC)曲线探寻C/V的最佳临界值。结果 :共247例患者符合研究标准,98例(39.7%)产生血栓;不同C/V大小血栓发生率不同,差异有统计学意义,χ~2=38.242,P<0.001;ROC曲线分析得出34%为C/V最佳临界值(灵敏度=83.7%,特异度=71.8%)。结论 :C/V越大血栓发生率越高。建议临床操作中,C/V应≤34%,若静脉直径为(0.29~0.41)cm,建议选择3Fr-PICC,前瞻性预防血栓的产生。Objective： To determine the effect of the PICC catheter/vein diameter （C/V） ratio on incidence of PICC- related venous thrombosis, and identify the optimal cut-off point of the C/V ratio. Methods： Adult patients were recruited between February 2016 and September 2016. Vein diameter at the PICC insertion site was measured using SiteRite 5 Ultrasound, and the vein was assessed by Doppler Ultrasonic examination. Participants were followed up at four weeks to determine if they developed PICC-related venous thrombosis. Receiver Operator Characteristic （ROC） was used to identify the optimal cut-off point of the C/V ratio. Results：Data were available for 247 patients. 98 patients （39.7%） developed PICC-related venous thrombosis. The differences of incidence of PICC-related venous thrombosis among different C/V ratios were significant （χ^2=38.242, P〈0.001）. ROC curve determined that a 34% C/V ratio was the optimal cut off point （sensitivity=83.7%, specificity=71.8%）. Conclusions：It was found that the C/V ratio was negatively related to the incidence of thrombosis. This study suggests that a 34% C/V ratio is the optimal cut off, and a 3Fr-PICC should be chosen if the vein diameter is （0.29-0.41） cm to prospectively prevent PICC-related venous thrombosis.

关 键 词：PICC 导管相关性静脉血栓 ROC 导管/静脉直径比例 最佳临界值 

分 类 号：R47[医药卫生—护理学]