肢体缺血预处理对乳腺癌患者PICC置管术后静脉血栓形成的影响  

Effect of limb ischemic preconditioning on venous thrombosis in patients with breast cancer after PICC

作　　者：马丽[1] 张元红[2] 陈会[3] 雷桂军[4] 田庆中[1] 郭浩[1] 王奕秋 李相成[5] 王云[1] MA Li;ZHANG Yuan-hong;CHEN Hui;LEI Gui-jun;TIAN Qing-zhong;GUO Hao;WANG Yi-qiu;LI Xiang-cheng;WANG Yun(Department of Surgical Oncology,Xuzhou Central Hospital,Xuzhou,Jiangsu 221009,China)

机构地区：[1]徐州市中心医院肿瘤外科,江苏徐州221009 [2]徐州市中心医院乳腺外科,江苏徐州221009 [3]徐州市中心医院神经内科,江苏徐州221009 [4]徐州市中心医院肿瘤内科,江苏徐州221009 [5]南京医科大学第一附属医院肝脏外科,江苏南京210029

出　　处：《中国临床研究》2019年第10期1368-1371,共4页Chinese Journal of Clinical Research

基　　金：徐州市科技局课题(KC16SH029,KC16SH039)~~

摘　　要：目的探讨对临床中乳腺癌患者经外周静脉穿刺中心静脉置管(PICC)前行肢体缺血预处理,在降低患者PICC置管后静脉血栓发生中的作用。方法选择2017年1月至2018年1月收治的乳腺癌术后行PICC置管患者共200例,随机分为对照组100例,不做缺血预处理(患者血压计袖带压力在0mmHg,无阻断及开放);观察组100例,PICC置管前行肢体缺血预处理(患者血压计袖带压力在200mmHg,持续5min,后开放5min,连续3个循环)。监测患者PICC置管后凝血功能指标;彩色多普勒超声检测PICC导管相关血栓发生情况;比较患者住院时间。结果两组患者PICC置管术后3d凝血酶原时间(PT)、部分活化凝血酶原时间(APTT)、凝血酶凝结时间(TT)、D-二聚体(D-D)及纤维蛋白原(FIB)水平比较无统计学差异(P均>0.05)。观察组患者PICC置管后导管相关血栓发生率低于对照组(21.00%vs35.00%,P<0.05)。观察组患者的住院时间短于对照组[(8.75±3.50)dvs(9.96±3.32)d,P<0.01]。结论PICC置管前对乳腺癌患者行肢体缺血预处理,在一定程度上可以降低PICC导管相关血栓的发生率。Objective To investigate the effect of limb ischemic preconditioning before peripherally inserted central catheter (PICC) on reducing venous thrombosis in patients with breast cancer after PICC. Methods A total of 200 patients with breast cancer receiving PICC after surgery from January 2017 to January 2018 were selected and divided into control group (the cuff pressure of the blood pressure gauge was 0 mm Hg without interruption or opening, n = 100) and experimental group (the cuff pressure of the blood pressure gauge was 200 mm Hg for 5 minutes and then opened for 5 minutes, lasting for 3 cycles, n = 100 ). The coagulation function after PICC, the incidence of PICC-related thrombosis by color Doppler ultrasound and the average hospitalization time were compared between two groups. Results There were no significant differences in prothrombin time (PT),activated partial prothrombin time ( APTT),thrombin coagulation time (TT),D-dimer ( D-D) and fibrinogen ( FIB) within 3 days after PICC between two groups ( all P >0. 05). Compared with control group, the incidence of catheter-related thrombosis(21. 00% vs 35. 00%,P <0. 05) and average hospitalization time [(8. 75 ± 3. 50 ) d vs ( 9. 96 ± 3. 32 ) d, P < 0. 01 ] statistically decreased in experimental group. Conclusion Limb ischemic preconditioning before PICC can reduce the incidence of PICC-related thrombosis to a certain extent in patients with breast cancer.

关 键 词：经外周静脉穿刺中心静脉置管 肢体缺血预处理 乳腺癌 血栓 

分 类 号：R543.6[医药卫生—心血管疾病]