头颈部肿瘤患者PICC相关性上肢静脉血栓危险因素的前瞻性研究

Risk factors of PICC related upper extremity venous thrombosis in patients with head and neck neoplasm:a prospective study

目的探讨头颈部肿瘤患者PICC相关性上肢静脉血栓形成的发生率和危险因素,为预防血栓形成提供依据。方法采用前瞻性队列研究,采用便利抽样法选择2016年1月—2018年3月行PICC置管的1137例头颈部肿瘤患者进行B超随访检查上肢静脉血栓发生情况。采用单因素和多因素Cox回归确定PICC相关性上肢深静脉血栓危险因素。结果3.6%(41/1137)患者发生PICC相关性上肢静脉血栓。多因素Cox回归分析显示:年龄越大(RR=1.04,95%CI:1.01~1.07,P=0.013)、有PICC置管史(RR=3.22,95%CI:1.53~6.77,P=0.002)、送管次数越多(RR=1.98,95%CI:1.30~3.00,P=0.001)是PICC相关性上肢静脉血栓形成的独立危险因素。结论头颈部肿瘤患者PICC相关性上肢静脉血栓形成的发生率相对较低,年龄大、有PICC置管史、送管次数多是头颈部肿瘤患者PICC相关性上肢静脉血栓形成的独立危险因素,针对该类患者采取积极的干预措施,有望降低PICC相关性血栓的发生率。

Objective To explore the incidence and risk factors of peripherally inserted central catheter(PICC)related upper extremity venous thrombosis(UEVT)in patients with head and neck neoplasm so as to provide a basis for preventing thrombosis.Methods This study used the design of prospective cohort study.From January 2016 to March 2018,UEVT follow-up examination by B ultrasound was carried out for 1137 head and neck neoplasm patients with PICC selected by convenience sampling.Single factor and multivariate Cox regression were used to determine the risk factors of PICC related UEVT.Results There were 3.6%(41/1137)of patients with PICC related UEVT.Multivariate Cox regression showed that the independent risk factors of PICC related UEVT included the older patients(RR=1.04,95%CI:1.01-1.07,P=0.013),being with a history of PICC catheterization(RR=3.22,95%CI:1.53-6.77,P=0.002)and high frequency of catheter delivery(RR=1.98,95%CI:1.30-3.00,P=0.001).Conclusions Patients with head and neck neoplasm have the low incidence of PICC related UEVT.The independent risk factors of PICC related UEVT in patients with head and neck neoplasm include the older ages,history of PICC catheterization and high frequency of catheter delivery.Positive intervention should be carried out for those patients which may reduce the incidence of PICC related thrombosis.