急性白血病患者经外周静脉穿刺置入中心静脉导管致静脉血栓形成的研究

Risk of Venous Thromboembolism Associated with Peripherally Inserted Central Catheter in Patients with Acute Leukemia

目的回顾性分析急性白血病患者置入中心静脉导管(PICC)后导管相关深静脉血栓形成的发生率(PICC-DVT)及影响因素。方法 46例急性白血病患者PICC置管后按有无PICC-DVT分血栓组及非血栓组,并分析PICC-DVT与患者年龄、性别、血常规、凝血功能、疾病类型、疾病状态、疾病预后、感染、置管长度、化疗及置管后1月内使用止血药的关系。用SPSS 17.0进行统计分析。结果 10/46例(21.8%)患者出现PICC-DVT,未发生肺梗塞。PICCDVT患者均未拔管,予药物抗凝治疗后血栓均溶解。高危急性白血病患者PICC-DVT高于非高危者,为8/8例比2/28例(χ~2=11.5,P=0.001),血栓组及非血栓组两组间置管时患者年龄、性别、血常规、凝血功能、急性白血病类型、疾病完全缓解(CR)/疾病复发(RR)/初发、PICC前后1月内有无肺部感染/化疗/使用止血药、及置管长度均无差异(P>0.05)。结论本文发现急性白血病预后为高危者PICC-DVT发生率相对更高。虽然急性白血病患者PICC-DVT发生率高,但无致命性肺栓塞发生,在留管状态下积极抗凝治疗可安全有效消除血栓。此外,血液肿瘤患者PICC-DVT发生可能与血常规、凝血功能、感染、疾病状态、化疗及使用止血药无关。

Objective To retrospectively analyze the incidence and risk factors of peripherally inserted central catheter- related deep venous thrombosis （ PICC- DVT） in acute leukemia patients. Methods 46 patients with acute leukemia who received PICC were studied and were divided into PICC-DVT group and non- PICC- DVT group between January 2013 and July 2016. Several risk factors of PICC- DVT were analyzed, such as age, gender, peripheral blood, coagulation function, types of acute leukemia, disease status （ new diagnosis, relapse, complete remission）, infection, lengths of PICC insertion, chemotherapy, and the use of hemostatic in 1 month after PICC. The data was analyzed by the software SPSS 17.0 withnest and chi-square test. Results Symptomatic PICC-DVT confirmed by ultrasound occurred in（21.8% ） 10/46 patients without pulmonary embolism. PICC-DVT was dispeared wtih thrombolysis therapy. The incidence rates of PICC-DVT in poor prognosis of acute leukemia was significantly higher than non-poor prognosis of acute leukemia （8/8 vs2/28 ,X^2 = 11.5, P = 0. 001 ）. There were no significant difference between PICC- DVT group and non PICC-DVT group in age, gender, peripheral blood, coagulation function, types of acute leukemia, disease status （ newly diagnosed, relapse, complete remission） , infection, lengths of PICC insertion, chemotherapy, and the use of hemostatie in 1 month after PICC （P 〉 0.05 ）. Conclusion In this paper, we first found that the incidence of PICC-DVT was higher in the patients with poor prognosis of acute leukemia. Although the high incidence of PICC-DVT in those patients, thrombolysis therapy were safe and effective and without pulmonary embolism.