肺癌患者PICC相关静脉血栓的回顾性分析

Retrospective Analysis of Peripherally Inserted Central Catheter-related Vein Thrombosis in Lung Cancer Patients

背景与目的经外周置入中心静脉导管(peripherally inserted central catheter,PICC)相关静脉血栓会给患者带来极大危害和经济负担,是不容忽视的PICC相关并发症。本研究旨在探讨肺癌患者置入PICC发生静脉血栓的相关因素,以降低PICC相关静脉血栓的发生率,延长导管使用时间。方法将2010年1月-2013年9月间住院化疗安置PICC的1,538例肺癌患者纳为研究对象,对发生PICC相关静脉血栓的患者进行回顾性分析,分析患者年龄、性别、置管静脉、置管肢体、血小板计数、凝血酶原时间(prothrombin time,PT)、纤维蛋白原(fibrinogen,FIB)值与发生静脉血栓有无相关性。结果在1,538例置管患者中,发生静脉血栓38例,发生率为2.47%。患者的年龄、置管肢体、血小板计数、PT对PICC相关性静脉血栓的发生的影响差异无统计学意义(P>0.05),性别(OR=2.194,P=0.024)、置管静脉(OR=1.955,P=0.006)、FIB值(OR=2.055,P=0.028)对PICC相关性静脉血栓的发生的影响差异有统计学意义;女性患者发生率高于男性患者,头静脉置管的发生率高于肘正中静脉、贵要静脉置管,FIB>4 g/L的患者发生率高于FIB≤4 g/L的患者。结论患者性别、置管静脉、FIB值与PICC相关静脉血栓的发生密切相关。在PICC护理工作中,应详细评估患者的情况,进行个体化护理,从而有效降低PICC相关静脉血栓发生率,延长导管使用时间。

Background and objective It has been proven that peripherally inserted central catheter-related vein thrombosis is a tmignorable complication which causes serious harm and economic burden to patients. We designed a study to analyze factors causing peripherally inserted central catheter （PlCC）-related vein thrombosis, and find some nursing interven- tions to reduce the incidence of PICC-related vein thrombosis, and prolong the service time of peripherally inserted central catheters. Methods We designed a retrospective analysis. The study participants were 1,538 lung cancer patients who under- went PICCs placement between January 2010 and September 2013. And tried to determine age, gender, indwelling vein, plate- let count, prothrombin time, fibrinogen associated with PlCC-related vein thrombosis. Results Of the 1,538 unique PICC placements, 38 patients developed PlCC-related vein thrombosis, the incidence was 2.47%. The gender （OR=2.194, P=0.024）, indwelling vein （OR=1.955, P=0.006）, fibrinogen （OR=2.055, P=0.028） can significantly affect the occurrence of PICC- related vein thrombosis. Conclusion Patients＇ gender, indwelling vein, fibrinogen can affect the occurrence of PICC-related vein thrombosis. Assessing the patients＇ condition carefully, implementing individual nursing care can reduce the incidence of PICC-related vein thrombosis, and prolong the service time of PICCs.