血液恶性肿瘤患者导管相关静脉血栓形成的危险因素及低分子肝素预防作用研究  

Study on risk factors of catheter-related venous thrombosis and prevention effect of low-molecular-weight heparin in patients with hematological malignancies

作　　者：黎建云[1] 涂传清[1] 彭玲[1] 黄灿[1] 张旭艳[1] 王典文 郑彩凤 Li Jianyun;Tu Chuanqing;Peng Ling;Huang Can;Zhang Xuyan;Wang Dianwen;Zheng Caifeng(Department of Hematology,Baoan District People's Hospital of Shenzhen City,Shenzhen 510108,China)

机构地区：[1]深圳市宝安区人民医院血液内科,510108

出　　处：《肿瘤研究与临床》2019年第10期679-683,共5页Cancer Research and Clinic

基　　金：深圳市宝安区科技创新局(2016CX179);广东医科大学校院联合科研基金(L2016018)。

摘　　要：目的探讨血液恶性肿瘤患者经外周静脉穿刺中心静脉置管(PICC)后导管相关静脉血栓(PICC-DVT)的发生情况及危险因素,同时分析低分子肝素预防抗凝治疗的安全性。方法收集2016年8月至2018年6月深圳市宝安区人民医院行PICC的43例血液肿瘤患者,按随机数字表法分为低分子肝素抗凝组(22例)及空白对照组(21例),比较两组患者PICC前后及血栓形成时的血常规、凝血四项、D-二聚体、蛋白C活性、蛋白S活性、抗凝血酶Ⅲ活性。结果43例患者中,PICC后1个月内发生PICC-DVT共5例(11.62%),其中低分子肝素抗凝组2例(9.09%),空白对照组3例(14.29%),两组差异无统计学意义(P=0.664)。所有PICC-DVT患者均未发生肺栓塞。空白对照组1例发生PICC-DVT及导管相关金黄色葡萄球菌感染,经抗感染、溶栓治疗后拔管,其余PICC-DVT患者均未拔管,予药物抗凝治疗后血栓均溶解。低分子肝素抗凝组及空白对照组PICC时白细胞计数、血小板计数、凝血酶原时间、活化部分凝血活酶时间、D-二聚体、蛋白C活性、蛋白S活性、抗凝血酶Ⅲ活性比较,差异均无统计学意义(均P>0.05)。5例PICC-DVT患者抗凝指标(蛋白C、蛋白S或抗凝血酶Ⅲ活性)均减低,而38例非血栓患者中抗凝指标减低16例,两者差异有统计学意义(P=0.021)。结论血液恶性肿瘤患者发生PICC-DVT时蛋白C、蛋白S或抗凝血酶Ⅲ活性减低的发生率低于非血栓患者。低分子肝素预防抗凝治疗不能减少血液恶性肿瘤患者PICC后1个月内PICC-DVT的发生,但治疗安全好,无相关出血事件。Objective To investigate the incidence and risk factors of catheter-related venous thrombosis(PICC-DVT)after peripherally inserted central catheter(PICC)in patients with hematologic malignancies,and to analyze the safety of anti-coagulation therapy with low-molecular-weight heparin.Methods From August 2016 to June 2018,43 patients with hematologic malignancies received PICC in Baoan District People's Hospital of Shenzhen City were enrolled.The patients were divided into low-molecular-weight heparin anticoagulation group(22 cases)and blank control group(21 cases)according to the random number table method.The blood routine,coagulation quadruple,D-dimer,protein C activity,protein S activity,and antithrombinⅢactivity before and after catheterization were compared between the two groups.Results Of the 43 patients,5 cases(11.62%)occurred PICC-DVT within 1 month after PICC,including 2 cases(9.09%)in the low-molecular-weight heparin anticoagulation group,and 3 cases(14.29%)in the blank control group,the difference between the two groups was not statistically significant(P=0.664).No pulmonary embolism occurred in all patients with PICC-DVT.One case in the blank control group developed PICC-DVT and catheter-associated staphylococcus aureus infection,the patient was extubated after anti-infection and thrombolytic therapy,the other patients with PICC-DVT were not extubated,and the thrombus was dissolved after anticoagulant therapy.There were no significant differences in the white blood cell count,platelet count,prothrombin time,activated partial thromboplastin time,D-dimer,protein C activity,protein S activity,and antithrombinⅢactivity between the low-molecular-weight heparin anticoagulation group and blank control group(all P>0.05).The anticoagulant index(protein C,protein S or antithrombinⅢactivity)was decreased in 5 patients with PICC-DVT,and in 38 non-thrombotic patients,the anticoagulant index was reduced in 16 patients(42.11%),the difference was statistically significant(P=0.021).Conclusions The incidence of pr

关 键 词：血液肿瘤 经外周静脉穿刺中心静脉置管 抗凝血酶Ⅲ 蛋白C 蛋白S 导管相关血栓 

分 类 号：R47[医药卫生—护理学]