肿瘤患者导管相关性血栓的会诊与治疗体会  

Experience in consultation and treatment of cancer patients with catheter-related thrombosis

作　　者：李振振[1] 刘敏[2] 张帅[3] 曾昭凡[1] 陈浩[1] 肖占祥[1] 戚悠飞[1] LI Zhenzhen;LIU Min;ZHANG Shuai;ZENG Zhaofan;CHEN Hao;XIAO Zhanxiang;QI Youfei(Department of Vascular Surgery,Hainan General Hospital/Hainan Affiliated Hospital of Hainan Medical University,Haikou 570311,China;Department of Medical Examination of Health Care Center,Hainan General Hospital/Hainan Affiliated Hospital of Hainan Medical University,Haikou 570311,China;Department of Radiotherapy,Hainan General Hospital/Hainan Affiliated Hospital of Hainan Medical University,Haikou 570311,China)

机构地区：[1]海南省人民医院/海南医学院附属海南医院血管外科,海南海口570311 [2]海南省人民医院/海南医学院附属海南医院保健中心体检部,海南海口570311 [3]海南省人民医院/海南医学院附属海南医院放疗科,海南海口570311

出　　处：《中国普通外科杂志》2022年第6期806-812,共7页China Journal of General Surgery

基　　金：海南省自然科学基金资助项目(820MS135)。

摘　　要：背景与目的:经外周穿刺中心静脉导管(PICC)为需要长时间输注化疗药物的肿瘤患者提供了一条安全的静脉治疗通道,然而,随着PICC在临床上的普及,血栓、感染、静脉炎、导管脱落、移位等相关并发症也越来越多,尤其是PICC导管相关性血栓(CRT),严重干扰肿瘤相关科室的诊疗活动,同时影响患者的预后。本研究通过回顾性分析肿瘤患者CRT的会诊意见及处理结果,探讨肿瘤患者CRT的处理策略。方法:回顾性分析2014年4月23日—2020年1月10日由海南省人民医院血管外科会诊的92例放疗科CRT患者的临床资料。所有患者均由彩超检查明确诊断,其中无症状74例(80.4%),感染症状9例(9.8%),血栓症状9例(9.8%)。会诊的主要问题包括:拔管时机及能否续用;是否进行抗栓治疗;是否需要制动等。结果:48例(52.2%)建议直接拔除导管(无症状者43例、感染症状者3例、血栓症状者2例);30例(32.6%)建议继续使用导管(无症状者23例、感染症状者3例、血栓症状者4例);14例(15.2%)建议延迟拔管并暂停使用导管(无症状者8例、感染症状者3例、血栓症状者3例)。32例(34.8%)建议行抗凝和(或)抗血小板等的抗栓治疗(无症状者20例、感染症状者4例、血栓症状者8例),另外60例(62.5%)未建议受抗栓治疗。共4例(4.3%)建议行患肢制动(感染症状者1例,血栓症状者3例),余88例(95.7%)未建议患肢制动或会诊中未提及。所有92例患者遵照会诊意见处理,无症状性或致死性肺栓塞发生,无血栓新发或加重事件等发生。在74例无症状患者中分析显示,是否行抗栓治疗以及患肢是否制动均对该类患者肺栓塞的发生无明显影响(均χ^(2)=0,P>0.05)。结论:无症状CRT患者可直接拔管或继续使用导管,并适当活动患肢,抗栓治疗无明显临床获益。合并感染患者应个体化处理,感染较重者,可适当抗凝、制动;感染较轻,不推荐抗凝,并可适当活动患肢。症状�Background and Aims:The peripherally inserted central catheter(PICC)provides a safe therapeutic venous access for cancer patients requiring long-term infusions of chemotherapeutic agents.However,with the widespread use of PICC in clinical practice,the PICC-related complications such as thrombosis,infections,phlebitis,and catheter disconnection or displacement have substantially increased,especially the catheters related thrombosis(CRT)in PICC,which seriously interferes the patient management activities of the cancer care departments,and also affects the prognosis of patients.Therefore,this study was performed to investigate the treatment strategies for CRT in cancer patients through a retrospective analysis of the consultation opinions for these patients and their treatment results.Methods:The clinical data of 92 cancer patients with CRT who were consulted by the physicians in the Department of Vascular Surgery of Hainan Provincial People's Hospital from April 23,2014 to January 10,2020 were retrospectively analyzed.All patients were definitively diagnosed by color ultrasound examination.Of the patients,74 cases(80.4%)were asymptomatic,9 cases(9.8%)had infection symptoms,and 9 cases(9.8%)had symptoms of thrombosis.The consultation questions mainly included that the timing of extubation or feasibility of maintaining intubation,requirement of antithrombotic therapy,and necessity of immobilization.Results:Direct extubation was recommended in 48 patients(52.2%,43 cases without symptoms,3 cases with infection symptoms and 2 cases with symptoms of thrombosis);continuous intubation was advised in 30 cases(32.6%,23 cases without symptoms,3 cases with infection symptoms and 4 cases with symptoms of thrombosis);delayed extubation and discontinuation of PICC were suggested in 14 patients(15.2%,8 cases without symptoms,3 cases with infection symptoms and 3 cases with symptoms of thrombosis);antithrombotic therapy with anticoagulation and(or)antiplatelet medications were considered in 32 case(34.8%,20 cases without symptoms,4

关 键 词：血栓形成 导管插入术 外周 血栓溶解疗法 肺栓塞 

分 类 号：R654.3[医药卫生—外科学]