肿瘤患者CVC/PICC置管术后静脉血栓发生的影响因素

Effect of vascular care on venous thrombosis after venipuncture in tumor patients

目的探讨肿瘤患者中心静脉穿刺(CVC)/外周静脉穿刺(PICC)置管术后静脉血栓发生的影响因素。方法纳入我院肿瘤中心2016年1月～2018年1月行CVC/PICC置管术的住院化疗患者234例,分为血栓组(66例)和无血栓组(113例),回顾性分析其年龄、性别、肿瘤类型(血液系统肿瘤和非血液系统肿瘤)、化疗次数、凝血酶原时间(PT)、置管时间、随访时间及随访方式、活动频率及强度等与静脉血栓发生的相关性。结果所有纳入者中静脉血栓发生率为26.92%;单因素分析结果显示肿瘤类型、凝血酶原时间(PT)、化疗次数、置管时间、随访方式及活动与静脉血栓的发生有相关性(P<0.05);多因素分析提示置管时间和随访方式是静脉置管术后血栓形成的独立危险因素(P<0.05);置管时间大于14天会显著升高静脉血栓发生率(P<0.05),规律门诊随访的患者静脉血栓发生率低于电话及其它方式随访者(P<0.05),且门诊随访更易在血栓形成早期发现。结论 CVC/PICC静脉置管术患者肿瘤类型、PT、化疗次数、置管时间、随访方式及时间、活动频率及强度与静脉血栓形成相关。医护人员日常护理中应及时识别血栓形成高风险因素,加强对患者的宣教,嘱其按时门诊随访并及时拔出导管,从而降低CVC/PICC置管术后静脉血栓的发生率,提高肿瘤患者护理质量,降低置管术后静脉血栓的形成风险。

Objective To investigate the influencing factors of venous thrombosis after venous puncture (CVC)/peripheral venous puncture (PICC) in patients with cancer.Methods The hospitalized chemotherapy patients underwent CVC/PICC catheterization from January 2016 to January 2018 in our hospital were retrospectively analyzed for age,sex,tumor type (blood system tumor and non-hematologic tumor),and number of chemotherapy.The prothrombin time (PT),catheterization time,follow-up time and follow-up,activity frequency and intensity were associated with venous thrombosis.Results 234 patients met the inclusion criteria were enrolled,and 63 of them developed venous thrombosis (incidence rate 26.92%).There was no significant correlation between age,gender and thrombosis rate ( P >0.05).Univariate analysis showed that tumor type,prothrombin time (PT),number of chemotherapy,catheterization time,follow-up mode and activity were correlated with venous thrombosis ( P <0.05).Multivariate analysis indicated that catheterization time and follow-up were independent risk factors for thrombosis after venous catheterization ( P <0.05).The catheterization time was greater than 14 days,which significantly increased the incidence of venous thrombosis.The rate of venous thrombosis in patients with regular outpatient follow-up was lower than that of telephone and other follow-up,and outpatient follow-up was more likely to be detected early in thrombosis.Conclusion Tumor type,PT,number of chemotherapy,catheterization time,follow-up mode and time,activity frequency and intensity of venous catheterization are associated with venous thrombosis.The daily care of medical staff should identify the high risk factors of thrombosis,strengthen the mission of patients,and follow up on time and out of the catheter in time to reduce the incidence of venous thrombosis after CVC/PICC catheterization.