重症肺结核患者中心静脉导管相关血栓形成的影响因素分析  

Analysis of influencing factors of central venous catheter related thrombosis in patients with severe pulmonary tuberculosis

作　　者：赵艳丽[1] 易丹 张立 耿雪侠[1] 叶寰 Zhao Yanli;Yi Dan;Zhang Li;Geng Xuexia;Ye Huan(Department of Pulmonary and Critical Care Medicine,Beijing Chest Hospital,Capital Medical University,Beijing Tuberculosis and Thoracic Tumor Institute,Beijing 101149,China)

机构地区：[1]首都医科大学附属北京胸科医院呼吸与危重症医学科,101149

出　　处：《北京医学》2025年第1期33-36,共4页Beijing Medical Journal

摘　　要：目的探讨呼吸重症监护室(respiratory intensive care unit,RICU)重症肺结核患者中心静脉导管相关血栓形成(catheter related thrombosis,CRT)的发生情况及影响因素。方法选取2021年7月1日至2023年10月1日北京胸科医院RICU重症肺结核患者,收集患者一般资料和临床资料,分别计算CRT发生率、经中心静脉置管(central venous cath⁃eter,CVC)和经外周静脉置入中心静脉导管(peripherally inserted central catheter,PICC)的CRT发生率。采用多因素非条件logistic回归方程分析RICU重症肺结核患者发生CRT的影响因素,采用ROC曲线的AUC评价危险因素对发生CRT的预测价值。结果共纳入34例患者,其中男23例、女11例,年龄13~84岁,平均(62.3±18.8)岁。CRT发生率为14.7%,经CVC和PICC的CRT发生率分别为10.3%和40.0%。CRT总发病密度为9.26/1000导管日,CVC和PICC的CRT发病密度分别为6.96/1000导管日和18.35/1000导管日。多因素分析结果显示,中心静脉导管放置时间越长(OR=1.072,95%CI:1.006~1.143,P=0.033)的患者发生CRT的风险越高。中心静脉导管放置时间预测CRT的ROC曲线的AUC为0.786(95%CI:0.525~1.000,P=0.044),cut-off值为33 d,灵敏度为0.600,特异性为0.966。结论RICU重症肺结核患者的PICC相关性CRT发生率较高。中心静脉导管放置时间是CRT的危险因素,置管>33 d时CRT的发生率会明显升高。Objective To investigate the incidence and influencing factors of central venous catheter related thrombosis(CRT)in patients with severe pulmonary tuberculosis in respiratory intensive care unit(RICU).Methods Patients with severe pulmonary tuberculosis in RICU of Beijing Chest Hospital from July 1st,2021 to October 1st,2023 were selected,the general and clinical data of patients were collected,and the incidence of CRT,CRT with central venous catheter(CVC)and peripherally inserted central catheter(PICC)were calculated respectively.Multivariate unconditional logistic regression equation was used to analyze the influencing factors of CRT in severe pulmonary tuberculosis patients in RICU,and ROC curve was used to evaluate the predictive value of risk factors for CRT.Results A total of 34 patients were included,including 23 males and 11 females,aged from 13 to 84 years,with an average of(62.3±18.8)years.The incidence of CRT was 14.7%,and the incidence of CRT via CVC and PICC was 10.3%and 40.0%respectively.The total incidence density of CRT was 9.26/1000 catheter day,and the incidence density of CRT in CVC and PICC was 6.96/1000 catheter d and 18.35/1000 catheter d,respectively.Multivariate analysis results showed that the patients with longer placement time of the central venous catheter(OR=1.072,95%CI:1.006-1.143,P=0.033)were more likely to develop CRT.The AUC of the ROC curve,the cut-off value,the sensitivity and the specificity of placement time of the central venous catheter for predicting CRT was 0.786(95%CI:0.525-1.000,P=0.044),33 d,0.600 and 0.966 respectively.Conclusions The incidence of PICC-related CRT in patients with severe pulmonary tuberculosis in RICU is high.The duration of catheterization is a risk factor for CRT,and the incidence of CRT will increase significantly when the catheterization time is longer than 33 d.

关 键 词：重症肺结核 导管相关血栓形成 中心静脉置管 外周静脉置入中心静脉导管 呼吸重症监护室 

分 类 号：R521[医药卫生—内科学]