肿瘤患者PICC相关性上肢静脉血栓形成的风险评估指标体系的构建

Establishment of a risk assessment index system for PICC-related upper extremity venous thrombosis in tumor patients

目的探究肿瘤患者PICC相关性上肢静脉血栓形成的风险评估指标体系的构建。方法 2017年1月-2018年11月,本院收治PICC置管恶性肿瘤形成相关性上肢静脉血栓患者50例(血栓组),选取同期收治的未形成相关性上肢静脉血栓的PICC置管恶性肿瘤50例为参照对象(非血栓组),分析肿瘤患者PICC相关性上肢静脉血栓形成的风险,制定风险评估指标体系。结果多因素回归分析显示:肿瘤患者PICC相关性上肢静脉血栓形成的独立风险因素有:贵要静脉穿刺、合并糖尿病、既往血栓史、置管史、使用抗凝药物、D-二聚体指标> 0.5mg/L、置管侧肢体肿胀、卧床时间大于72h。无血栓组的血栓形成风险得分、95%CI均小于血栓组,肿瘤患者PICC相关性上肢静脉血栓形成的危险分级情况可以分为1级、2级、3级。结论针对PICC相关性上肢静脉血栓形成的风险因素,构建风险评估指标体系,能够区分血栓形成的危险患者,能够根据风险评估,开展针对性处理,可以减少血栓形成率。

Objective To explore the establishment of a risk assessment index system for PICC-associated upper limb venous thrombosis in tumor patients. Methods From January 2017 to November 2018, 50 patients with upper limb venous thrombosis associated with PICC catheterization malignant tumor(thrombus group)were chosen as subjects. 50 patients with PICC catheterization malignant tumor without associated upper limb venous thrombosis were selected as control group(non-thrombus group). The risk of PICC-associated upper limb venous thrombosis in tumor patients was analyzed and a risk assessment index system was established.Results Multivariate regression analysis showed that there was a correlation between PICC in tumor patients. The independent risk factors of limb venous thrombosis were as follows: venous puncture, diabetes mellitus, previous thrombus history, catheterization history,use of anticoagulant, D-dimer index > 0.5 mg/L, limb swelling on the side of catheterization, bed rest time more than 72 hours. The risk scores of thrombosis in the non-thrombus group were lower than those in the thrombus group. The risk grades of PICC-associated upper limb venous thrombosis in tumor patients could be divided into grade 1, grade 2 and grade 3. Conclusion According to the risk factors of PICC-associated upper limb venous thrombosis, the risk assessment index system can be constructed to distinguish the risk patients with thrombosis. Risk assessment and targeted treatment can reduce thrombus formation rate.