外周静脉置入中心静脉导管术后上肢深静脉血栓形成的相关因素分析

Analysis of related factors of deep venous thrombosis in upper extremity after PICC catheterization

目的探讨引起经外周静脉置入中心静脉导管(Peripherally inserted central catheter,PICC)相关性上肢深静脉血栓形成的相关危险因素。方法选取2014年1月至2018年2月解放军第一一七医院肿瘤内科接受PICC置管的住院患者300例作为研究对象,最终确认置管后发生上肢深静脉血栓者30例(血栓组),其余270例则未发现上肢深静脉血栓(非血栓组)。收集患者的一般资料(性别、年龄、体质指数)、置管技术指标(穿刺次数、置管时长、导管尖端位置)、置留血管指标(置管侧肢体、置管静脉、置管静脉内径)、既往史(高血压病史、糖尿病病史、肿瘤病史、肿瘤化疗史、吸烟史、血栓史、PICC或CVP置管史)和实验室检查指标(血小板计数、血浆D-二聚体、血浆纤维蛋白原、凝血酶原时间),以单因素分析找出血栓组和非血栓组差异具有统计学意义的变量,再将这些变量代入logistic回归分析,找出导致PICC置管后上肢深静脉血栓形成的危险因素。结果单因素分析显示,血栓组与非血栓组具有差异性的变量有导管尖端位置、置管静脉内径、肿瘤病史、肿瘤化疗史和血浆D-二聚体(χ^2=4.556、10.973、11.940、5.357、11.623,P=0.033、0.001、0.001、0.021、0.001);多因素logistic回归分析得出,PICC置管术后上肢深静脉血栓形成的危险因素为导管尖端置于上腔静脉上2/3处、置管静脉内径<4mm、既往有肿瘤病史和肿瘤化疗史(P=0.014、0.023、0.017、0.028)。结论PICC置管术后上肢深静脉血栓形成的危险因素为导管尖端置于上腔静脉上2/3处、置管静脉内径<4mm、既往有肿瘤病史和肿瘤化疗史。

Objective To investigate the related risk factors of upper extremity deep venous thrombosis associated with peripherally inserted central catheter(PICC). Methods From January 2014 to February 2018, 300 patients with PICC in the No.117 Hospital of the Chinese People's Liberation Army were selected in the study, of whom 30 patients developed deep venous thrombosis(thrombosis group), the other 270 patients had no deep venous thrombosis(non-thrombotic group). General data of the patients (gender, age, body mass index), catheter technical parameters(number of punctures, length of catheter, position of catheter tip), retention vessel index(inner side of catheter, indwelling vein, internal diameter of catheter), past history(history of hypertension, history of diabetes, history of oncology, history of cancer chemotherapy, history of smoking, history of blood clots, history of PICC, or CVP insertion), and laboratory tests(platelet count, plasma D-dimer, plasma fibrin original, prothrombin time) were collected.Univariate analysis was used to find out the differences between the thrombosis group and the non-thrombosis group.Logistic regression analysis was used to identify the risk factors for deep vein thrombosis of the upper extremities after PICC catheterization. Results Univariate analysis showed that variables that differed between the thrombus group and the non-thrombosis group included catheter tip location, diameter of the cannulated vein, history of cancer, history of chemotherapy, plasma D-dimer (χ^2=4.556, 10.973, 11.940, 5.357, 11.623, P=0.033, 0.001, 0.001, 0.021, 0.001). Multivariate Logistic regression analysis showed that the risk factors of upper extremity deep venous thrombosis after PICC catheterization were catheter tip placement on the upper vena cava 2/3, catheter vein diameter<4mm, tumor history and chemotherapy history(P=0.014, 0.023, 0.017, 0.028). Conclusion The risk factors of upper extremity deep venous thrombosis after PICC catheterization are catheter tip placed on the upper 2/3 of the superior vena cava, diameter of the catheter vein<4 mm, tumor history and chemotherapy history.