乳腺癌术后患者患侧上肢置入PICC导管的临床应用及观察

Clinical Application and Observation of PICC Inserted through the Affected Upper Limb of Postoperative Breast Cancer Patients

目的：评价乳腺癌患者术后化疗患侧上肢置入PICC导管的安全性。方法：将2009年4月~2011年11月在我科住院治疗的乳腺癌改良根治术后需要化疗的患者148例分为两组,在健侧上肢置入PICC导管的72例患者作为对照组,在健侧上肢无法置管而于患侧上肢置入PICC导管的76例患者作为实验组。两组患者病理类型、分期、年龄、肿瘤所在位置、KPS评分、有无其他合并症、出凝血时间、化疗方案等一般资料,差异无统计学意义（P〉0.05）。比较两组置管一次性成功率、置管后常见并发症、导管使用时间的差异。结果：实验组和对照组置管一次性成功率分别为96.1%和94.4%;常见并发症中,静脉炎发生率分别为18.4%和25%,静脉血栓发生率分别为1.31%和2.77%,导管堵塞发生率分别为1.3%和2.8%,导管相关性感染发生率分别为2.6%和4.1%,穿刺处渗液发生率分别为2.6%和2.8%,差异无统计学意义（P〉0.05）;在使用时间上,实验组平均使用151.247±19.485天、对照组平均使用139.102±29.716天,实验组使用时间长于对照组,差异有统计学意义（P〈0.001）。结论：乳腺癌患者术后患侧上肢若一般情况良好,置入PICC导管是安全有效的,可在临床推广应用。

Objective： To evaluate the safety of PICC placement in the affected upper limb of the postoperative breast cancer patients. Methods：One hundred and forty-eight breast cancer patients who accepted modified radical mas-tectomy from April. 2009 to Nov. 2011 in our department were divided into two group. The control group included 72 pa-tients who were placed PICC in the upper limb on the healthy side. The experiment group enrolled 76 cases who were placed PICC in the affected upper limb . There was no significant difference between these two groups of the general data including pathological type, stage, age, tumor location, KPS score, presence of other complications, the function of blood coagulation, chemotherapy regimen. The one-time success rate of placement , the common complications after catheter placement and the using time of catteter were compared between these two groups. Results：The one-time success rate for PICC placement of the experiment group and control group were 96. 1% and 94. 4%,respectively. The incidence of phlebi-tis ,venous thrombus, catheter blockage, catheter related infection ,oozing at the puncture site were 18. 4% and 25%,1. 31% and 2. 77%, 1. 3% and 2. 8%,2. 6% and 4. 1% , 2. 6% and 2. 8%, respectively in experiment group and control group with no significant difference（P〉0. 05）. Significant difference was observed between experiment group （151. 247 ± 19. 485 days） and control group （139. 102 ± 29. 716 days） in the using time of catheter（P〈0. 001）. Conclusion：Inser-tion of PICC through the affected upper limb of postoperative breast cancer patients is safe if the condition of the upper limb is well. It is worthy of clinical application.