影响肺癌化疗患者PICC导管相关性静脉血栓的危险因素分析  

Analysis of Risk Factors Affecting PICC Catheter-related Venous Thrombosis in Patients with Lung Cancer Undergoing Chemotherapy

作　　者：范华颖[1] 方怡[2] FAN Hua-ying;FANG Yi(Department of Respiratory Medicine, the Third People' s Hospital of Chengdu, Chengdu 610031, China;Department of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu 610041, China)

机构地区：[1]成都市第三人民医院呼吸内科,成都610031 [2]四川大学华西医院中西医结合科,成都610041

出　　处：《临床误诊误治》2019年第9期54-58,共5页Clinical Misdiagnosis & Mistherapy

基　　金：四川省卫生和计划生育委员会基金项目(17PJ0245)

摘　　要：目的 分析影响肺癌化疗患者发生经外周中心静脉置管(peripherally inserted central catheter, PICC)导管相关性静脉血栓的危险因素。方法 回顾性分析我院2014年1月—2018年6月收治的184例行PICC置管的肺癌化疗患者的临床资料,根据有无血栓形成分为观察组( n =16)和对照组( n =168)。记录患者的一般资料、治疗情况及实验室指标,分析影响肺癌化疗患者发生PICC导管相关性静脉血栓的危险因素。结果 本研究16例发生PICC导管相关性静脉血栓,发生率为8.70%;发生位置为锁骨下静脉6例,腋静脉5例,肱静脉3例,颈内静脉2例;发生于PICC置管后2周7例,置管后2周~1个月6例,置管1个月后3例。单因素分析显示,两组肿瘤分期、病理分型、合并糖尿病、置管静脉、导管尖端位置、中心静脉导管(central venous catheter, CVC)和(或)PICC置管史、活动度、置管前D-二聚体水平比较差异具有统计学意义( P <0.05)。多因素logistic回归分析结果显示,肿瘤分期、合并糖尿病、导管尖端位置、活动度、置管前D-二聚体水平为PICC导管相关性静脉血栓发生的独立危险因素( P <0.05)。结论 在临床治疗、护理过程中,应结合患者具体情况,给予个性化处理,重视静脉血栓发生的危险因素,延长PICC导管使用时间,提高治疗效果。Objective To analyze the risk factors of peripherally inserted central catheter (PICC)-related venous thrombosis in patients with lung cancer undergoing chemotherapy. Methods The clinical data of 184 patients who received chemotherapy for lung cancer and underwent PICC catheterization in our hospital from January 2014 to June 2018 were retrospectively analyzed. And the patients were divided into observation group ( n =16) and control group ( n =168) according to the presence or absence of thrombosis. The general data, treatment conditions and laboratory indicators were recorded, and the risk factors for PICC catheter-related venous thrombosis in patients with lung cancer undergoing chemotherapy were analyzed. Results There were 16 cases with PICC catheter-related venous thrombosis in this study with the incidence rate of 8.70%. The onset location included subclavian vein ( n =6), axillary vein ( n =5), brachial vein ( n =3) and jugular vein ( n =2). There were 7 cases developing thrombosis at 2 weeks after catheterization, 6 cases at 2 weeks to 1 month after catheterization and 3 cases at 1 month after catheterization. Univariate analysis showed that there were statistically significant differences between the two groups in tumor stages, pathological types, combined diabetes mellitus, catheterization vein, position of catheter tip, central venous catheter (CVC)/PICC catheterization history, range of motion (ROM) and D-D level before catheterization ( P <0.05). Multivariate logistic regression analysis showed that tumor stages, combined diabetes mellitus, position of catheter tip, ROM and D-D level before catheterization were risk factors for PICC catheter-related venous thrombosis ( P <0.05). Conclusion In clinical treatment and nursing, individualized treatment should be given in combination with specific conditions of patients. And it is necessary to pay attention to risk factors for occurrence of venous thrombosis, prolong the indwelling time of PICC catheter and improve the quality of treatment.

关 键 词：静脉血栓形成 导管插入术 中心静脉 肺肿瘤 化学疗法 危险因素 

分 类 号：R543[医药卫生—心血管疾病]