ICU高凝状态患者中心静脉导管完全血凝堵塞危险因素分析

Risk factors of complete hemagglutination in central venous catheter in ICU patients with hypercoagulability

目的分析重症监护病房(ICU)高凝状态患者中心静脉导管完全血凝堵塞的危险因素,为预防导管完全血凝堵塞提供依据。方法选择2016年1月-2019年1月上海中医药大学附属曙光医院ICU收治的高凝状态中心静脉置管患者135例作为研究对象,按是否发生完全血凝堵塞分为堵塞组(n=29)与非堵塞组(n=106),采用单因素及多元Logistic回归分析筛选ICU高凝状态患者中心静脉导管完全血凝堵塞的危险因素。结果 135例患者中,发生完全血凝堵塞29例(21.48%),堵塞发生于输液间歇期22例(75.86%),全胃肠外营养时3例(10.34%),输液过程4例(13.79%);堵塞组年龄>60岁者比例高于非堵塞组(χ^2/P=5.122/0.023);堵塞组D-二聚体(D-D)、纤维蛋白降解产物(FDP)、血小板计数(PLT)、纤维蛋白原(Fib)高于非堵塞组(t=6.839、4.848、6.833、5.084,P均=0.000);堵塞组置管类型为经锁骨上或下静脉置管(CVC)(37.93%)、置管时间> 14 d(41.38%)、封管方式为生理盐水(86.21%)、冲封管操作不规范(27.59%)所占比例均高于非堵塞组(χ^2/P=4.133/0.042、4.088/0.043、4.442/0.035、4.069/0.043);Logistic回归分析显示,年龄[>60岁,OR(95%CI)=3.543(2.112~5.994)]、D-D[≥3.0 mg/L,OR(95%CI)=5.223(3.387~8.054)]、FDP[≥25.0μg/ml,OR(95%CI)=3.755(2.717~5.188)]、PLT[≥200×10~9/L,OR(95%CI)=2.776(1.040~7.411)]、Fib[≥5.0 g/L,OR(95%CI)=3.206(2.108~4.877)]、置管类型[CVC,OR(95%CI)=3.130(1.184~8.274)]、置管时间[>14 d,OR(95%CI)=5.842(2.994~11.397)]、封管方式[生理盐水,OR(95%CI)=3.068(1.018~9.249)]为ICU高凝状态患者中心静脉导管完全血凝堵塞的危险因素,冲封管规范操作为其保护因素(OR=0.360,95%CI 0.144~0.900)。结论 ICU高凝状态患者中心静脉导管完全血凝堵塞发生率较高,老年、高凝状态、CVC置管、置管时间> 14 d、生理盐水封管均为完全血凝堵塞的危险因素。

Objective To analyze the risk factors of complete hemagglutination of central venous catheter in intensive care unit(ICU) patients with hypercoagulable state,so as to provide basis for the prevention of complete hemagglutination of catheter.Methods A total of 135 patients with central venous catheterization in the hypercoagulable state who were admitted to the ICU of Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine from January 2016 to January 2019 were selected as the research subjects.They were divided into occluded group(n=29) and non-occluded group(n=106) according to whether complete clotting occurred.Single factor and multiple logistic regression analysis were used to screen the risk factors of complete hemagglutination of central venous catheter in patients with ICU hypercoagulability.Results Of the 135 patients,29(21.48%) had complete clotting,22(75.86%) occurred during the infusion interval,3(10.34%) occurred during total parenteral nutrition,and 4(13.79%) occurred during infusion.The proportion of those aged> 60 years in theocclusion group was higher than that in the non-occlusion group(x^2/P=5.122/0.023);D-dimer(D-D),fibrin degradation product(FDP),platelet count(PLT),fibrinogen(Fib) was higher than that in the non-occluded group(t=6.839,t=4.848,t=6.833,t=5.084,and P=0.000).The type of catheter in the blocked group was the supraclavicular or inferior vein catheter(CVC)(37.93%),intubation time> 14 d(41.38%),normal saline(86.21%),non-standard sealing tube operation(27.59%) were higher than those in the non-occluded group(χ^2/P=4.133/0.042,χ^2/P=4.088/0.043,χ^2/P=4.442/0.035,χ^2/P=4.069/0.043);Logistic regression analysis showed that age[> 60 years old,OR(95% CI)=3.543(2.112~5.994)],D-D[≥3.0 mg/L,OR(95% CI)=5.223(3.387 to 8.054)],FDP[≥25.0 μg/ml,OR(95% CI)=3.755(2.717~5.188)],PLT[200×10~9/L,OR(95% CI)=2.776(1.040~7.411)],Fib [≥5.0 g/L,OR(95% CI)=3.206(2.108~4.877)],type of tube [CVC OR(95% CI)=3.130(1.184~8.274)],tube placement time [> 14 d,OR(95% CI)=5.842(2.994~11.397)],tube sealing method [physiological saline,OR(95% CI)=3.068(1.018~9.249)] is a risk factor for complete coagulation of central venous catheters in patients with ICU hypercoagulability,and the standard operation of the sealed tube is its protective factor(OR=0.360,95% Cl 0.144~0.900).Conclusion The incidence of complete hemagglutination of central venous catheters in patients with ICU hypercoagulability is higher.The elderly,hypercoagulability,CVC catheterization,catheterization time> 14 d,and saline sealed tubes are all risk factors for complete hemagglutination.