分析恶性肿瘤患者PICC置管后非机械性堵管的影响因素

Analysis of Influencing Factors of Non-mechanical Catheter Blockage After Peripherally Inserted Central Venous Catheters for Malignant Tumor Patients

目的探讨恶性肿瘤患者经外周静脉穿刺中心静脉置管非机械性堵管的影响因素。方法选择2012年10月—2013年8月在本院放疗科接受抗肿瘤治疗与PICC置管的患者。自PICC初始即完整记录患者基本人口学资料、血液学指标、疾病因素、治疗因素,并记录置管、堵管、拔管时间及过程中发生的各种并发症。结果符合入组、排除标准的连续病例共112例。随访期间发生非机械系堵管32例,发生率28.5%。中位堵管时间46天。COX多元回归分析结果显示,堵管的保护因素为:原发部位为头颈部(P=0.024)及胸部肿瘤(P=0.014)、β2微球蛋白(P=0.044),危险因素为:合并糖尿病(P=0.023)。结论 PICC堵管高峰发生于置管后1—2个月内,合并糖尿病的恶性肿瘤患者较易发生PICC堵管,应重视PICC的定期维护与合并症处理。

Objective To discuss the influencing factors of non-mechanical catheter blockage after peripherally inserted central venous catheters for malignant tumor patients.Methods Patients who accepted anti tumor therapy and PICC in department of radiotherapy of our hospital from October 2012 to August 2013 were selected.The basic demographic materials,indexes of hematology,disease factors and treatment factors of the patients since the beginning of PICC were completely recorded,and the times of catheterization,catheter blockage and extubation and all kinds of complications in the process were recorded.Results There were totally 112 consecutive patients that could meet the entry and exclusion standards.The non-mechanical catheter blockage occurred on 32 patients in the follow-up period,and the occurrence rate was 28.5%.The median catheter blockage time was 46 days.It was shown by the result of COX multiple repression analysis that,the protective factors of catheter blockage were： the primary sites were head and neck（P=0.024） and thoracic neoplasms（P=0.014）,β2 microglobulin（P=0.044）,and the risk factors were： gestational diabetes mellitus（P=0.023）.Conclusion Peak time of PICC catheter blockage occurs within 1 or 2 months after catheterization,and PICC catheter blockage is much easier to occur on malignant tumor patients with gestational diabetes mellitus,so the regular maintenance and treatment for complications should be attached importance.