肿瘤化疗患者并发输液港导管相关血栓的危险因素及治疗策略  

Analysis of risk factors and treatment strategies of implantable venous access port catheter-related thrombosis in chemotherapeutic patients

作　　者：周振宇 顾喜喜[4] 鲍旭霞[4] 夏罕生 范越 虞奋[1,2,3] 史振宇 ZHOU Zhen-yu;GU Xi-xi;BAO Xu-xia;XIA Han-sheng;FAN Yue;YU Fen;SHI Zhen-yu(Department of Vascular Surgery,Zhongshan Hospital,Fudan University,Shanghai 200032,China;Institute of Vascular Surgery,Fudan University,Shanghai 200032,China;National Clinical Research Center for Interventional Medicine,Shanghai 200032,China;Department of Integrative Medicine,Zhongshan Hospital,Fudan University,Shanghai 200032,China;Department of Ultrasound,Zhongshan Hospital,Fudan University,Shanghai 200032,China)

机构地区：[1]复旦大学附属中山医院血管外科,上海200032 [2]复旦大学血管外科研究所,上海200032 [3]国家放射与治疗临床医学研究中心,上海200032 [4]复旦大学附属中山医院中医-中西医结合科,上海200032 [5]复旦大学附属中山医院超声科,上海200032

出　　处：《复旦学报（医学版）》2022年第6期898-904,954,共8页Fudan University Journal of Medical Sciences

基　　金：国家自然科学基金(81870342)。

摘　　要：目的探讨肿瘤化疗患者并发输液港(implantable venous access port,IVAP)导管相关血栓的危险因素,并分析治疗策略。方法2021年3—7月前瞻性连续纳入复旦大学附属中山医院274例使用输液港化疗的肿瘤患者。超声筛查患者IVAP导管相关血栓发生情况,并以此分为血栓发生组和未发生IVAP导管相关血栓组。搜集患者基线和病历资料,多因素Logistic回归分析肿瘤化疗患者并发IVAP导管相关血栓的危险因素,并对发生血栓的患者进行3个月的初步抗凝治疗(D-二聚体<0.8 mg/L的患者用10 mg/d利伐沙班抗凝,D-二聚体≥0.8 mg/L的患者用20 mg/d利伐沙班抗凝),随访发生血栓组患者的治疗结果。结果274例肿瘤患者中有35例(12.8%)患者发生IVAP导管相关血栓。多因素Logistic回归分析表明发生相关血栓的独立危险因素包括合并有远处转移(OR=3.013)、化疗前纤维蛋白原≥400 mg/dL(OR=3.226)、新辅助+辅助化疗方式(OR=26.286)。随访发现所有IVAP导管相关血栓阳性患者抗凝用药后无局部症状发生或加重,患者均未出现肺栓塞,1例因肠道出血停药,1例轻度牙龈出血,1例轻度鼻黏膜出血。有超声复查的5位患者在新型口服抗凝药作用下附壁血栓消失或变小。结论IVAP相关血栓的危险因素为化疗前纤维蛋白原≥400 mg/dL、有远处转移、新辅助+辅助化疗方式,临床应注意筛查。D-二聚体<0.8 mg/L的患者可使用10 mg/d的利伐沙班;D-二聚体≥0.8 mg/L的患者可使用20 mg/d的利伐沙班抗凝。Objective To investigate the risk factors and to analyze treatment strategies of implantable venous access port(IVAP)catheter-related thrombosis in chemotherapeutic patients.Methods A total of 274 chemotherapeutic patients who underwent IVAP placement were prospectively and consecutively enrolled in our hospital from Mar to July 2021.The patients were divided into the group with IVAP catheter-related thrombosis and the group without IVAP catheter-related thrombosis according to the results of the occurrence of IVAP catheter-related thrombosis screened by color Doppler ultrasound.Baseline characteristics and medical history were collected.Multivariable Logistic analysis was used to evaluate the risk factors of IVAP catheter-related thrombosis in chemotherapeutic patients.The patients with IVAP catheter-related thrombosis were treated with preliminary novel oral anticoagulants for 3 months and were followed up on the outcome of anticoagulant therapy(Rivaroxaban of 10 mg/d doses and 20 mg/d doses was used for patients with D-dimer<0.8 mg/L and D-dimer≥0.8 mg/L,respectively).Results Among 274 patients,IVAP catheter-related thrombosis occurred in 35 patients(12.8%).The possible independent risk factors of IVAP catheter-related thrombosis in chemotherapeutic patients included patients with metastasis(OR=3.013),fribrinogen≥400 mg/dL(OR=3.226)before chemotherapy,and adjuvant+neoadjuvant chemotherapy(OR=26.286).No local symptoms occurred or got worse after anticoagulant therapy in all the patients with IVAP catheter-related thrombosis during follow-up.None of the patients developed pulmonary embolism.Drug withdrawal occurred in one patient due to intestinal hemorrhage.One patient had mild gingival bleeding and one had mild epistaxis.Mural thrombus disappeared or became smaller in 5 patients receiving novel oral anticoagulants after ultrasonic review.Conclusion Fibrinogen≥400 mg/dL before chemotherapy,metastasis,and adjuvant+neoadjuvant chemotherapy are independent risk factors of IVAP catheter-related thrombosis for

关 键 词：肿瘤 输液港(IVAP) 导管相关血栓 危险因素 预后 

分 类 号：R543[医药卫生—心血管疾病]