上肢加压与握拳运动方案对PICC置管患者血流动力学的影响

Effects of upper limb compression and clench fist movement on hemodynamics among patients withperipherally inserted central catheter

目的 比较上肢加压与握拳对PICC 置管患者上肢静脉血流动力学的影响，为预防PICC 相关性血栓新策略寻求理论支持。方法 2018 年1—2 月采用便利抽样法，选取解放军总医院71 例 PICC 置管患者，采用自身前后对照方法，在患者平静状态、PICC 置管侧上肢加压20、40、60 mmHg 及握拳时，测量患者腋窝处PICC 置管静脉血流峰速度。采用SPSS 22.0 统计软件分析加压后和握拳后血流峰速度的变化。结果 患者平静状态下静脉血流峰速度中位数为7.61 cm/s，握拳后静脉血流峰速度中位数为20.38 cm/s，加压至20 mmHg 静脉血流峰速度中位数为18.48 cm/s，加压至40 mmHg 静脉血流峰速度中位数为23.37 cm/s，加压至60 mmHg 静脉血流峰速度中位数为25.54 cm/s，不同状态下血流峰速度比较差异有统计学意义（F=278.97，P ＜ 0.01），其中，握拳及20、40、60 mmHg 加压后的血流峰速度均高于平静状态，20 mmHg 压力状态下血流峰速度低于40、60 mmHg 压力状态下血流峰速度，差异有统计学意义（P＜ 0.05）。握拳后血流峰速度与20、40、60 mmHg 加压后血流峰速度呈正相关关系（r值分别为 0.66、0.72、0.71；P ＜ 0.01）。血流动力学波形图中，患者握拳后引起的血流速度变化曲线较平缓，而上肢40 mmHg加压引起的血流速度变化曲线较陡峭。结论 上肢加压可有效增加上肢静脉血流速度，达到握拳引起的上肢血流速度水平，若使用上肢加压替代握拳预防PICC 相关性血栓，40 mmHg 可能为较适宜的加压压力值。

Objective To explore the effects of upper limb compression and clench fist on hemodynamics of upper of limbs veins among patients with peripherally inserted central catheter（ PICC）, so as to provide theoretical support for the new strategy of preventing PICC related thrombus. Methods From January to February 2018, we selected 71 patients with PICC in Chinese PLA General Hospital by convenience sampling. The self before-after control was used to measure peak velocity of blood flow at vein with PICC in patients＇ armpit when patients were in a calm state, the compression of the upper limb with PICC was 20, 40,60 mmHg and after fists were clenched. SPSS 22.0 was used to analyze the change of blood flow peak velocity after compression and clench fist. Results The median of vein blood flow peak velocity was 7.61, 20.38,18.48, 23.37 and 25.54 cm/s respectively when patients were in a calm state, after fists were clenched and when the compression was 20, 40, 60 mmHg with significant differences（ F=278.97, P〈 0.01）. The blood flow peak velocity after fists were clenched and the compression was 20, 40, 60 mmHg was higher than that when patients were in calm state; the blood flow peak velocity when the compression was 20 mmHg was lower than that when the compression was 40 and 60 mmHg（ P 〈 0.01）. The blood flow peak velocity after fists were clenched had positive correlations with those after the compression was 20, 40, 60 mmHg respectively（ r=0.66, 0.72, 0.71;P〈 0.01）. In the oscillogram of hemodynamics, the change curve of blood flow rate was gentle after fists were clenched. However, the change curve of blood flow rate was abrupt when the compression for upper limb was 40 mmHg. Conclusions The compression for upper limb can effectively increase blood flow rate of upper limb vein to achieve the level of blood flow rate of upper limb caused by clenching fist. If clenching fist is replaced by upper limb compression to prevent PICC related thrombus, 40 mmHg may be the appropriate pressure value of compression.