外周静脉穿刺置入中心静脉导管置管术后血栓的预防

Study on the Thrombus after Peripherally Inserted Central Venous Catheter

目的探讨外周静脉穿刺置入中心静脉导管(PICC)穿刺置管术后血栓的发生及其预防措施。方法以2015年5月至2016年10月我院收治的90例PICC穿刺置管治疗的患者为对象,盲法随机分为对照组(置管期间实施常规对症处理,n=45)和观察组(在对照组基础上另实施针对性预防措施,n=45),比较两组术后住院时间、下床活动时间和静脉血栓发生率,观察治疗后两组凝血功能指标[活化部分凝血活酶时间(a PTT)、纤维蛋白原(Fbg)、凝血酶原时间(PT)]、预后效果[急性生理学与慢性健康状况评分系统Ⅱ(APACHE Ⅱ)评分]及并发症发生情况。结果与对照组相较,观察组住院时间、下床活动时间明显短(t=8.950、13.376,P <0.05),术后静脉血栓发生率明显低(x^2=5.404,P<0.05);术前两组aPTT、Fbg、PT、APACHEⅡ评分相较无明显差异(P> 0.05);与术前相较,术后两组aPTT、Fbg、PT明显减小,APACHEⅡ评分明显降低(P <0.05),且术后观察组各项指标变化幅度较对照组明显大,差异显著(P <0.05)。结论凝血功能异常是PICC置管术后血栓形成的重要因素,全面监测PICC穿刺置管患者凝血指标,采取预防措施是降低PICC相关性血栓并发症的关键。

Objective To investigate the occurrence and preventive measures of thrombus after peripherally inserted central venous catheter (PICC)catheterization.Methods 90 patients undergoing PICC catheterization in our hospital from May 2015to October 2016were selected as subjects,and they were randomly divided into the control group (given routine symptomatic treatment during catheterization,n =45 )and the observation group (given preventive measures on the basis of treatment for the control group,n =45 ).The length of hospital stay,ambulation time and the incidence of venous thrombosis were compared between the two groups.Coagulation indexes [activated partial thromboplastin time (aPTT),fibrinogen (Fbg),prothrombin time (PT)],the prognosis [Acute Physiology and Chronic Health Evaluation Ⅱ (APACHEⅡ)score ]and the incidence of complications in the two groups were observed before and after treatment.Results The length of hospital stay and ambulation time of the observation group were significantly shorter than those of the control group(t =8.950,13.376 ,P <0.05 ),and the incidence of postoperative venous thrombosis was significantly lower than that in the control group (χ^2 =5.404,P <0.05 ).There was no significant difference between the two groups in aPTT,Fbg,PT and APACHE Ⅱ score before operation (P >0.05 ).After operation,the APTT, Fbg,PT and APACHE Ⅱ scores in the two groups were decreased significantly (P <0.05 ),and the changes in the indicators in the observation group were significantly greater than those in the control group (P <0.05 ).Conclusion Abnormal blood coagulation is the important influencing factor of thrombus after PICC catheterization.In clinical practice,blood coagulation indexes in patients undergoing PICC catheterization should be comprehensively monitored.Reasonable preventive measure is the key to reduce the incidence of PICC associated thrombus and complications,promote the rehabilitation of patients and improve the prognosis.