消化道恶性肿瘤PICC化疗患者非计划拔管的影响因素  

Factors influencing unplanned extubation in patients undergoing PICC chemotherapy for gastrointestinal malignancies

作　　者：杨薇薇 牛媛媛 张迪娜 罗冰 谢华红 Yang Weiwei;Niu Yuanyuan;Zhang Dina;Luo Bing;Xie Huahong(Department of Gastroenterology,the First Affiliated Hospital of PLA Air Force Medical University,Xi’an Shaanxi 710032,China)

机构地区：[1]中国人民解放军空军军医大学第一附属医院消化内科,陕西西安710032

出　　处：《遵义医科大学学报》2025年第4期361-368,共8页Journal of Zunyi Medical University

基　　金：陕西省创新能力支撑计划项目(NO:2022PT-48)。

摘　　要：目的探讨消化道恶性肿瘤经外周静脉穿刺中心静脉置管(PICC)化疗患者非计划性拔管(UE)的影响因素。方法纳入本院在2019年2月至2024年1月收治的消化道恶性肿瘤PICC化疗患者513例,收集其临床资料,采用Logistic回归模型分析UE的影响因素及原因,并采用受试者工作特征(ROC)曲线分析预测变量准确性。结果513例患者中467例正常拔管,46例UE,UE率8.97%(46/513)。Logistic回归模型多因素结果显示:年龄、D-二聚体(D-D)水平、体外留置导管长度2 cm U型固定、导管脱出、术后持续性发热、导管相关性感染、导管相关血栓形成是消化道恶性肿瘤PICC化疗患者UE的独立危险因素(P<0.05)。ROC结果显示:上述危险因素独立及联合预测消化道恶性肿瘤PICC化疗患者UE均有统计学意义(P<0.05),其中联合预测的AUC=0.972,95%CI为0.941~1.000,灵敏度为0.935,特异度为0.940。结论消化道恶性肿瘤PICC化疗患者UE的独立危险因素为年龄、D-D水平、体外留置导管长度2 cm U型固定、导管脱出、术后持续性发热等,临床需高度重视,加强监测及管理,以降低UE风险,确保治疗安全。Objective To investigate the factors influencing unplanned extubation(UE)in patients undergoing transperipheral venous peripherally inserted central catheter(PICC)for chemotherapy of gastrointestinal malignancies.Methods A total of 513 patients with PICC chemotherapy admitted to our hospital from February 2019 to January 2024 were included.Their clinical data were collected,the influencing factors and causes of UE were analyzed by the Logistic regression model,and the receiver working characteristics(ROC)curve was used to analyze the accuracy of predictive variables.Results Of the 513 patients,467 were normally extubated and 46 were UE,with a UE rate of 8.97%(46/513).The multivariate results of Logistic regression model showed that age,D-dimer(D-D)level,external indwelling catheter length 2 cm U fixation,catheter prolapse,persistent postoperative fever,catheter-related,catheter-related infection,and catheter-related thrombosis were independent risk factors for UE in PICC chemotherapy(P<0.05).ROC results showed that the above independent risk factors and the combined prediction of PICC chemotherapy patients were statistically significant(P<0.05),with the combined prediction AUC=0.972,95%CI of 0.941-1.000,sensitivity of 0.935 and specificity of 0.940.Conclusion The independent risk factors for UE in patients with PICC chemotherapy are age,D-D level,indwelling catheter length 2 cm U,catheter prolapse,and persistent postoperative fever,etc.We should pay great attention to it and strengthen monitoring and management to reduce the risk of UE and ensure the safety of treatment.

关 键 词：消化道恶性肿瘤 经外周静脉穿刺中心静脉置管 化疗 非计划性拔管 影响因素 

分 类 号：R735[医药卫生—肿瘤]