肿瘤化疗间歇期PICC规范维护情况及影响因素研究

Standardized PICC maintenance situation at the intermission of chemotherapy and its influence factors

目的探讨肿瘤化疗间歇期经外周静脉穿刺中心静脉置管术(PICC),规范维护率及影响因素,为采取预防干预措施提高PICC规范维护率提供参考。方法采用便利抽样法抽取2014年4月—2015年8月金华市4家市级医院120例间歇期PICC带管出院的肿瘤化疗患者作为研究对象,患者置管后均建立PICC维护记录,治疗间歇期携带、完善维护记录,统一问卷调查了解维护情况和并发症情况,统计分析患者间歇期PICC规范维护率和不规范事项,对研究组患者采用单因素和多因素法分析PICC规范维护的影响因素。结果患者PICC规范维护率较低,规范维护率52.50%(63/120),不规范维护包括PICC个案不完善(7.50%)、自我观察和专业检查缺失(15.83%)、敷贴和封管固管方式不正确(10.00%)、PICC定期维护和消毒不及时(25.83%)、出现严重并发症和非正常拔管(18.33%),单因素分析,年龄、合并T2DM、置管时间、体温、D-二聚体组间差异有统计学意义(均P<0.05),多因素分析显示,年龄(OR=3.467,95%CI:1.755~6.453)、是否合并T2DM(OR=5.225,95%CI:2.612~10.774)、体温(OR=2.596,95%CI:1.387~5.895)、D-二聚体(OR=7.515,95%CI:2.369~19.454)是独立的影响因素。结论肿瘤化疗间歇期PICC规范维护率较低,高龄、合并T2DM、发热、D-二聚体升高可能是PICC不规范维护的危险因素,应针对性地开展预防干预提高PICC规范维护率。

Objective To study the standardized peripherally inserted central catheter（PICC） maintenance rate at the in- termission of chemotherapy and its influence factors, and to provide evidence for preventive intervention to increase of normative PICC maintenance rate. Methods A total of 120 cancer chemotherapy patients once discharged with PICC in treatment intermission from April,2014 to August,2015 in four municipal hospitals in Jinhua were chosen as research objects. Maintenance records of all patients were established. Patients completed maintenance record at the intermission of chemotherapy,and were surveyed PICC maintenance situation and complication via questionnaires. Normative PICC main- tenance rate and ill-formed maintenance were analyzed, and influence factors on PICC maintenance of study group were analyzed by single factor and multi-factor methods. Results Standardized PICC maintenance rate was low,and normative maintenance rate of study group was 52. 50% （63/120）. Ill-formed maintenance included incomplete PICC case （7.50%）, deficiency of self-observation and specialized examination （ 15.83% ）, incorrect method of sealing and fixing （ 10. 00% ）, irregularity of maintenance and disinfection （ 25. 83% ）, serious complication and improper drawing （18.33 % ）. Single analysis revealed statistical differences in age, complication with T2DM,remaining time of PICC, tem- perature, D-Dimer between groups （ P 〈 0.05 ） , and multi-analysis revealed that age （ OR = 3. 467,95% CI： 1. 755 - 6. 453 ）, complication with T2DM （ OR = 5. 225,95 % C1：2.612 - 10. 774）, temperature （ OR = 2. 596,95 % CI： 1. 387 - 5. 895 ） and D-Dimer（ OR = 7. 515,95% CI：2. 369 - 19. 454） were independent influence factors. Conclusion Standard- ized PICC maintenance rate at the intermission of chemotherapy was low, and advanced age, fever and raise of D-Dime are supposed to be the risk factors of non-standard PICC maintenance, and preventive intervention should be taken to increase normative maintenance rate.