外周植入式静脉输液港并发症50例分析与处理

Analysis and treatment of complications in peripheral totally implantable venous access port

目的探讨外周植入式静脉输液港(TIVAP)在乳腺癌化疗病人中的临床应用情况,了解其临床可行性、实用性和安全性。方法回顾性分析重庆医科大学附属第一医院2017年3月至2018年6月使用外周TIVAP行多疗程化疗的201例病例临床资料。比较各类并发症的构成比差异,以及改良加压包扎与常规加压包扎发生切口出血、改良植入方法与常规植入方法发生导管异位、左/右外周静脉置港后发生导管异位的病例差异。结果201例病人术后共发生并发症50例(24.9%),其中切口出血15例(7.5%),导管相关性血栓4例(2.0%),底座暴露3例(1.5%),囊袋感染4例(2.0%),导管异位15例(7.5%),回抽无血7例(3.5%),导管相关上肢运动受限2例(1.0%)。拟合优度检验(等比例)比较各类并发症的构成比差异(χ~2=30.520,P<0.001),即并发症不服从等比例分布,其中切口出血和导管异位占比最高;常规加压包扎方式(78例)与改良加压包扎方式(123例)发生切口出血比较,差异有统计学意义[11例(14.1%)vs.4例(3.3%),χ~2=6.642,P=0.010];常规置港方法(90例)与改良置港方法(121例)发生导管异位比较,差异有统计学意义[9例(10.0%)vs.3例(2.4%),χ~2=4.131,P=0.042];经左(106例)/右(95例)外周静脉置港后发生导管异位的比较,差异无统计学意义[8例(7.5%)vs.7例(7.3%),χ~2=0.020,P=0.962]。结论通过安全管理、密切观察及积极治疗,外周TIVAP并发症可获得有效控制。若不存在禁忌证,TIVAP仍然是一种安全有效、可长期临床使用的静脉输液通道。

Objective To explore the clinical application of the peripheral totally implantable venous access port(TIVAP)in breast cancer chemotherapy patients,and to understand the clinical applicability and safety of peripheral TIVAP.Methods The clinical data of 201 cases using peripheral TIVAP of multi-course chemotherapy in the First Affiliated Hospital of Chongqing Medical University from March 2017 to June 2018 were analyzed retrospectively.The difference of composition ratio of various complications,and difference between the conventional pressure bandaging method and the modified pressure bandaging method for incision hemorrhage,the conventional implantation method and the improved implantation method for catheter ectopic and the difference of the catheter ectopic after left/right peripheral vein TIVAP placement were compared.Results There were 50 cases(24.9%)of postoperative complications,15 cases(7.5%)of incision hemorrhage,4 cases(2.0%)of catheter-related thrombosis,3 cases(1.5%)of base exposure,4 cases(2.0%)of sack infection,15 cases(7.5%)of primary catheter ectopic,7 cases(3.5%)with no blood withdrawal,2 cases(1.0%)with catheter-related upper limb movement limitation.Using the goodness of fit test(equal ratio)to compare the composition ratio of various complications,χ~2=30.520,P<0.001,the proportion of complications was not obeyed,and the proportion of incision hemorrhage and catheter ectopic was the highest.The conventional pressure bandaging method(78 cases)and the modified pressure bandaging method(123 cases)showed incision bleeding,and the difference was statistically significant[11 cases(14.1%)vs.4 cases(3.3%),χ~2=6.642,P=0.010];the conventional implantation method(90 cases)and the modified implantation method(121 cases)were compared with catheter ectopic,and the difference was statistically significant[9 cases(10.0%)vs.3 cases(2.4%)χ~2=4.131,P=0.042];there was no statistically significant difference in catheter ectopic position after left(106 cases)/right(95 cases)peripheral TIVAP implantation[8 cases(7.5%)vs.7 cases(7.3%),χ~2=0.020,P=0.962].Conclusion The complication of peripheral TIVAP can be effectively controlled through safe management,close observation and active treatment.TIVAP is still a safe and effective intravenous infusion channel for long-term clinical use if there is no contraindication.