人工肝股静脉置管导管相关性血栓的影响因素分析  

Risk factors of catheter-related thrombosis in femoral vein indwelling catheter for patients undergoing artificial liver therapy

作　　者：章华芬[1] 陈辉[1] 张鑫[1] 魏柳毅 陈琴仙[1] 张卓瑶 王晓燕[1] 黄丽华[2] Zhang Huafen;Chen Hui;Zhang Xin;Wei Liuyi;Chen Qinxian;Zhang Zhuoyao;Wang Xiaoyan;Huang Lihua(Department of Infectious Diseases,the First Affiliated Hospital,Zhejiang University School of Medicine,Hangzhou 310003,China;Department of Nursing,the First Affiliated Hospital,Zhejiang University School of Medicine,Hangzhou 310003,China)

机构地区：[1]浙江大学医学院附属第一医院感染病科,杭州310003 [2]浙江大学医学院附属第一医院护理部,杭州310003

出　　处：《中华临床感染病杂志》2024年第3期213-217,共5页Chinese Journal of Clinical Infectious Diseases

基　　金：国家自然科学基金(82300697)。

摘　　要：目的探讨人工肝治疗股静脉置管发生导管相关性血栓(catheter-related thrombosis, CRT)的影响因素, 为CRT的管理提供参考依据。方法回顾性收集2019年2月26日至2022年3月30日浙江大学医学院附属第一医院人工肝中心1 060例因肝脏疾病接受非生物型人工肝治疗且留置股静脉导管患者的临床资料, 并将其分为CRT组(n=574)和非CRT组(n=486)。采用多因素Logistic回归分析人工肝股静脉置管发生CRT的影响因素。结果 1 060例人工肝股静脉置管患者CRT发生率为54.2%(574/1 060)。单因素分析显示, 性别、置管前后D-二聚体、国际标准化比值(international normalized ratio, INR)、总胆红素、置管位置和留置时间是人工肝股静脉置管后发生CRT的影响因素(P值均<0.05)。多因素Logistic回归分析显示, 男性[OR=1.627, 95%可信区间(CI)1.233~2.148, P<0.001]、右股静脉置管(OR=2.101, 95%CI 1.130~3.908, P=0.019)、留置时间(OR=1.039, 95%CI 1.003~1.077, P=0.035)、置管后D-二聚体>500 μg/L FEU(OR=1.697, 95%CI 1.191~2.416, P=0.003)、INR≥1.5(OR=1.343, 95%CI 1.001~1.801, P=0.049)是人工肝股静脉置管CRT的高危因素。结论人工肝股静脉置管CRT发生率高, 临床上医护人员应早期识别其高风险人群, 并及时采取预防措施。ObjectiveTo explore the risk factors of catheter-related thrombosis(CRT)in femoral vein indwelling catheter for patients undergoing artificial liver therapy.MethodsThe clinical data 1060 patients who received non biological artificial liver therapy with femoral vein catheterization at the Artificial Liver Center of the First Affiliated Hospital,Zhejiang University School of Medicine from February 26,2019 to March 30,2022 were retrospectively analyzed.During the treatment,CRT occurred in femoral vein indwelling catheter in 574 cases(54.2%,CRT group)and did not occurred in remaining 486 cases(non-CRT group).The influencing factors of CRT were analyzed with multiple Logistic regression.ResultsUnivariate analysis showed that gender,D-dimer before and after catheterization,international normalized ratio(INR),total bilirubin,catheterization location,and catheter retention time were significantly associated with the occurrence of CRT(all P<0.05).Multiple Logistic regression analysis showed that male gender(OR=1.627,95%CI 1.233-2.148,P<0.001),right femoral vein catheterization(OR=2.101,95%CI 1.130-3.908,P=0.019),catheter retention time(OR=1.039,95%CI 1.003-1.077,P=0.035),D-dimer>500μg/L FEU after catheterization(OR=1.697,95%CI 1.191-2.416,P=0.003)and INR≥1.5(OR=1.343,95%CI 1.001-1.801,P=0.049)were independent risk factors for CRT in femoral vein indwelling catheter for artificial liver therapy.ConclusionThe incidence of CRT is high in patients undergoing artificial liver therapy with femoral vein catheterization.In clinical practice,medical staff should early identify high-risk populations for CRT and take timely preventive measures.

关 键 词：人工肝支持治疗 股静脉置管 导管相关性血栓 影响因素 

分 类 号：R575[医药卫生—消化系统]