改良中心静脉导管置入术在肿瘤化疗患者中的应用

Clinical application of located subcutaneous jugular vein inserted central catheter in cancer patients

目的改良静脉中心导管置入术在恶性肿瘤化疗患者中的临床应用效果。方法选取我院2013年1月—2016年12月需使用导管进行化疗的恶性肿瘤患者,按照置管时间分为实验组和对照组,分别利用改良中心静脉导管置入术和PICC对患者进行穿刺置管,比较其导管留置时间和并发症发生率,绘制Kaplan-Meier生存曲线反映两组的导管相关性血流感染(catheter-related blood stream infections,CRBSIs)的发生情况并进行log-rank检验,分析CRBSIs的病原菌分布,进行多因素Cox回归分析。结果本研究共纳入450例患者,其中实验组228例,对照组222例。实验组的平均留置天数(212.24±79.80)d显著长于对照组(79.73±34.86)d。实验组并发症发生率和CRBSIs发生率显著低于对照组(P<0.01)。CRBSIs的病原菌分布排名前三位的依次为葡萄球菌、假丝酵母菌和肺炎克雷伯杆菌。置管位置、置管方式和肿瘤类型是感染的独立危险因素。结论采用改良中心静脉导管置入术进行置管的并发症发生率更降低,导管留置时间延长,更能满足肿瘤患者的化疗需求。

Objective To explore the clinical application of located subcutaneous jugular vein inserted central catheter （LSJICC） in patients with malignant tumors. Methods The patients with malignant tumors treated in our hospital from January 2013 to December 2016 were enrolled and divided into the experimental group and the control group according to the order of catheterization. Two groups were catheterized with LSJICC and PICC,respeetively. Indwelling time of the catheter and incidence of complications were compared between two groups. The Kaplan- Meier survival curve was used to reflect the occurrence of CRBSIs in both groups,and the log-rank lest was used to compare the results. The pathogenicity distribution of CRBSIs was analyzed and multivariate Cox regression analysis was performed. Results A total of 450 patients were enrolled in this study,including 228 patients in the experimental group and 222 patients in the control group. The average indwelling time of the catheter in the ex- perimental group（212.24 ± 79.80） was significantly longer than that in the control group（79.73 ± 34.86）. The incidence of complications in the experimental group was significantly lower than that in the control group. The CRBSIs Kaplan-Meier survival curve of the experimental group was significantly better than that of the control group（P〈0.01）. The top three pathogens of CRBSIs were staphylococcus aureus,candida and klebsiella pneumoniae. Multivariate Cox regression analysis of CRBSIs showed that the site of catheter placement,the method of catheter placement and the type of tumor were independent risk factors for infection. Conclusion The incidence of complications are significantly reduced with LSJICC,and indwelling time of the catheter is significantly prolonged,which is more in line with the actual needs of cancer patients undergoing chemotherapy.