肿瘤患者化学治疗静脉通路选择现状及影响因素分析  

Current Status of Intravenous Access for Chemotherapy:A Multicenter Retrospective Cohort Study

作　　者：高丽[1] 冯晶晶[1] 邓艳梅 郭玲[1] 王国蓉[1] 杨青[1] 罗蕾[1] Gao Li;Feng Jingjing;Deng Yanmei(Sichuan Clinical Research Center for Cancer,Sichuan Cancer Hospital&Institute,Sichuan Cancer Center,Affiliated Cancer Hospital of University of Electronic Science and Technology of China,Chengdu,Sichuan 610041 China)

机构地区：[1]四川省肿瘤临床医学研究中心·四川省肿瘤医院·研究所·四川省癌症防治中心·电子科技大学附属肿瘤医院,四川成都610041

出　　处：《四川医学》2023年第12期1238-1242,共5页Sichuan Medical Journal

基　　金：2020年四川省卫生健康委员会课题(编号:20PJ119)。

摘　　要：目的调查四川地区肿瘤患者化学治疗静脉通路选择情况,分析化学治疗静脉通路改变的影响因素,为临床化学治疗静脉通路选择提供参考。方法对首次输注化疗药物的患者静脉通路进行追踪观察,包括留置针、经外周静脉置入中心静脉导管(PICC)、中心静脉导管(CVC)等输液通路,统计患者化学治疗全程静脉通路使用情况,并分析静脉通路改变的影响因素。结果527例患者化学治疗全程仅使用中心静脉通路者占比83.87%,仅使用外周静脉通路占比12.90%,混合使用中心与外周静脉通路占比3.23%。未更改静脉通路的患者473例,更改静脉通路患者54例。未更改静脉通路中,PICC为241例(45.73%)、CVC为174例(33.02%)、留置针58例(11.01%)。更改静脉通路中,使用外周静脉后更改为中心静脉占10例(1.90%),使用中心静脉后更改为外周静脉占5例(0.95%),外周中心交替使用占2例(0.38%),使用CVC后更改为PICC占17例(3.23%),使用PICC更改为CVC为10例(1.90%),钢针留置针交替使用完成治疗的患者10例(1.90%)。多因素分析显示女性(OR=2.531,P=0.047),高学历,如本科(OR=13.510,P<0.001),乳癌(OR=5.580,P=0.025),肿瘤专科医院(OR=3.071,P=0.018)增加静脉通路改变风险。结论四川地区成人化疗药物静脉通路选择多样化,包括钢针、留置针、中心静脉导管等通路。影响患者通路改变的因素与患者性别、文化程度、肿瘤类型及医院性质有关,部分患者静脉通路选择缺乏前瞻性,致患者经历反复穿刺,需加强相关管理,保护患者血管,减少资源浪费。Objective To investigate the selection of venous access for chemotherapy in Sichuan province,analyze the influencing factors of venous access for chemotherapy,and provide reference for the selection of venous access for clinical chemotherapy.Methods The venous access of patients who received the first infusion of chemotherapy drugs was tracked and observed,including indwelling needle,PICC,CVC and other infusion access.The use of venous access in the whole course of chemotherapy was counted,and the influencing factors of venous access changes were analyzed.Results In 527 patients,83.87%used only central venous access,12.90%used only peripheral venous access,3.23%used mixed central and peripheral venous access.There were 473 patients with unchanged venous access and 54 patients with altered venous access.There were 241 cases(45.73%)with PICC,174 cases(33.02%)with CVC,and 58 cases(11.01%)with indwelling needle in unchanged venous access.In changed venous access,10 cases(1.90%)were changed to central vein after use of peripheral vein,5 cases were(0.95%)changed to peripheral vein after use of central vein,2 cases were(0.38%)changed to peripheral center alternate use,17 cases were(3.23%)changed to PICC after use of CVC,and 10 cases were(1.90%)changed to CVC after use of PICC.In 10 patients(1.90%),steel needle indwelling needle was used alternately.Multiple factors analysis showed that women(OR=2.531,P=0.047),higher education,such as bachelor degree(OR=13.510,P<0.001),breast cancer(OR=5.580,P=0.025),tumor hospital(OR=3.071,P=0.018)increased the risk of venous pathway change.Conclusion The choice of intravenous access for adult chemotherapeutic drugs in Sichuan is diversified,including steel needle,indwelling needle,central venous catheter etc.The factors affecting the change of patients'access are related to patients'gender,education level,tumor type and hospital conditions.The selection of venous access in some patients is not forward-looking,causing patients to experience repeated puncture.Relevant management should b

关 键 词：肿瘤患者 化学治疗 静脉通路 影响因素 

分 类 号：R47[医药卫生—护理学]