肿瘤患者PICC无症状血栓形成与置管静脉直径、血流速度变化的相关性研究  

A symptomatic thrombosis in PICC patients and its correlation with changes in catheter diameter and blood flow velocity

作　　者：王志敏[1] 卫建宁[1] 杜萍[1] 何佩仪[1] 胡小芳 Wang Zhimin;Wei Jianning;Du Ping;He Peiyi;Hu Xiaofang(Department of Oncology,Guangzhou First People's Hospital,Guangzhou,510180,China)

机构地区：[1]广州市第一人民医院肿瘤科

出　　处：《现代临床护理》2019年第11期10-16,共7页Modern Clinical Nursing

基　　金：广东省医学科学技术研究基金，项目编号A2017061

摘　　要：目的探讨肿瘤患者PICC无症状血栓形成(简称为血栓形成)与置管静脉直径变化、血流速度变化的相关关系,为实施临床干预、有效降低血栓发生率提供循证依据。方法采用前瞻性队列研究方法,按序列抽取2018年1月至2019年1月108例接受PICC置管的肿瘤患者作为研究对象,在置管前、置管后1w、2w、3w、4w、6w、8w、10w、12w、14w、16w分别采用多普勒超声监测测量患者置管静脉直径变化及血流速度变化情况,根据有无发生无症状血栓分为两组,并分析其与置管静脉直径变化与血流速度变化的相关关系。结果肿瘤患者PICC无症状血栓形成59例(占54.6%),未发生49例(占45.4%)。未发生无症状血栓组(以下简称未发生血栓组)患者置管后置管静脉直径变化占比(不变、增加、减少:4.1%、28.6%、67.3%)与发生无症状血栓组(以下简称发生血栓组)(16.9%、40.7%、42.4%)比较,差异具有统计学意义(P=0.016);未发生血栓组血流速度变化分布(不变、增加、减少:0,32.6%,67.4%)与发生血栓组(6.8%,15.3%,78.0%)比较,差异具有统计学意义(P=0.025),且发生血栓组患者置管后静脉直径相对变化值[0(-0.2,0.3)mm]小于未发生血栓组[-0.3(-1.1,0.1)mm],P=0.002。结论肿瘤患者PICC置管后无症状血栓发生率较高;无症状血栓者其静脉直径不变或增粗高于未发生无症状血栓者,且血流较其减缓。Objective To explore the status of PICC-related asymptomatic(referred as thrombosis)in tumor patients and the relationship between thrombosis and changes of the diameter of catheterized vein and blood flow velocity,providing guidance for clinical intervention and effective reduction of thrombus incidence.Methods A prospective cohort study was performed to recruit 108 patients with PICC catheterization from January 2018 to January 2019.The diameter of the catheter and blood flow velocity of the patients were measured before and 1,2,3,4,6,8,10,12,14 and 16 week(s)after PICC catheterization.The patients were divided into two groups according to the presence of thrombosis.Correlations between changes in vessel diameter and changes in blood flow velocity were analyzed.Results There were 59 cases of thrombosis in tumor patients,accounting for 54.6%,and 51 cases(45.4%)did not develop with it.There was a statistically significant difference(P=0.016)in the proportion of the changes of diameter of catheter in the group without asymptomatic thrombus(unchanged,increased,decreased:4.1%,28.6%,67.3%),compared with that in the group with asymptomatic thrombus(16.9%,40.7%,42.4%).The difference of the distribution of blood flow velocity(unchanged,increased decreased:0%,32.7%,67.3%)in the asymptomatic thrombus group and the asymptomatic thrombus group(6.8%,15.3%,78.0%)was statistically significant(P=0.025)as well.We also found that the relative change of vein diameter after catheterization in patients with asymptomatic thrombus was higher than that without group[(0(-0.2,0.3)mm),(-0.3(-1.1,0.1)mm),P=0.002].Conclusions The incidence of asymptomatic thrombus in tumor patients after PICC catheterization was relatively high,and the venous diameter of asymptomatic thrombus patients was higher than that of asymptomatic thrombus patients,and the blood flow of asymptomatic thrombus patients was slower than that of asymptomatic thrombus patients.It can provide useful reference for clinical medical staff to give patients early prevention and

关 键 词：肿瘤患者 无症状血栓形成 经外周置入中心静脉导管 前瞻性队列研究 多普勒超声 

分 类 号：R473.73[医药卫生—护理学]