肿瘤患者长期中心静脉导管置入后静脉血栓形成的危险因素及护理

Risk Factors of venous Thrombosis after long-term Central Venous Catheter Placement in Patients with Tumor and Nursing care

目的探讨肿瘤患者长期中心静脉导管(PICC)置入后静脉血栓形成的危险因素及护理对策。方法选取2012年5月至2016年10月于我科行PICC的108例肿瘤患者作为研究对象,采用系统性回顾法分许所有患者的临床资料,根据其分析结果统计所有PICC患者中相关静脉血栓的形成情况,并比较是否血栓形成患者其临床资料间的差异以及护理方法。结果 (1)本组108例肿瘤患者行PICC后出现静脉血栓36例(33. 33%),其中对照组24例(22. 22%),干预组12例(11. 11%),比较差异间具有统计学意义(P <0. 05);(2)通过非条件单因素logistic回归模型分析可得,性别、年龄、肿瘤类型、置管时间、活动度、既往糖尿病、血栓史及病情严重和预防抗凝药物的未使用均可能为肿瘤患者PICC后静脉血栓形成的危险因(P <0. 05);(3)通过非条件多因素logistic回归模型分析可得,性别、年龄、肿瘤类型、置管时间、活动度、既往糖尿病和血栓史及病情程度和预防抗凝药物的未使用均为肿瘤患者PICC后静脉血栓形成的独立危险因素(P <0. 05)。结论性别、年龄、肿瘤类型、置管时间、活动度、既往糖尿病和血栓史及病情程度和预防抗凝药物的未使用均为肿瘤患者PICC后静脉血栓形成的独立危险因素,而针对危险因素制定相应的护理对策,可大大降低静脉血栓发生率。

Objective To investigate the risk factors of venous thrombosis associated with placement in central central venous catheters（PICC）in cancer patients and nursing strategies. Methods 108 patients with PICC were selected as the subjects admitted to our hospital from May 2012 to October 2016. The incidence of related venous thrombosis in all PICC patients was calculated according to the results of the analysis and the differences between the clinical data and the nursing methods were compared. The related risk factors of PICC patients complicated with venous thrombosis and the appropriate nursing methods were summarized. Results （ 1 ） There were 36 cases （ 33.33 % ） of venous thrombosis after PICC in 108 patients with tumor group, 24 cases （22.22%） in the control group and 12 cases （11.11%）in the intervention group, the difference was statistically significant（ P 〈 0.05 ） ; （2）Univariate single-factor logistic regression analysis was used to analyze the availability of sex, age, tumor type, catheterization time, activity, previous diabetes mellitus, thrombosis history and severe illness and prevention of anticoagulant drugs that may be risk factors for postoperative venous thrombosis of PICC patients （ P 〈 0.05 ） ; （ 3 ） Sex, age, tumor type, catheterization time, activity, previous diabetes mellitus, thrombosis history and severe illness and prevention of anticoagulant drugs were all independent risk factors for postoperative venous thrombosis of PICC patients by the analysis of unconditional multivariate logistic regression model （ P 〈 0. 05 ）. Conclusion Sex, age, tumor type, catheterization time, activity, previous history of diabetes mellitus and thrombosis and the severity of anticoagulant drugs were independent risk factors for postoperative venous thrombosis of PICC patients. It can greatly reduce the incidence of venous thrombosis by establishing appropriate nursing strategies for risk factors.