白血病患者行PICC治疗脆弱表型和缺陷累积脆弱指数的预测价值

Predictive value of fragile phenotype and cumulative vulnerability index of PICC for patients with leukemia

目的探究脆弱表型和缺陷累积脆弱指数预测白血病患者行PICC导管治疗并发局部感染的危险系数。方法选择2016年1月至2019年10月在本院进行化疗并接受PICC插管的117例白血病患者作为研究对象,统计白血病患者脆弱表型和脆弱指数评分评估脆弱性,采用多变量逻辑回归分析检测白血病患者导管局部感染的危险因素;同时从穿刺部位收集脓性分泌物样本进行细菌培养以明确其病原菌分布。结果117例白血病患者中共出现19例PICC导管局部感染,感染发生率为16.24%,ALL、CLL、AML、CML患者的PICC导管感染率比较差异无统计学意义(P>0.05)。不同类型患者的脆弱表型评分、脆弱指数评分及导管感染率比较差异均有统计学意义(均P<0.05),随着脆弱表型升级PICC导管感染比率增加,脆弱表型评分与PICC导管感染比率呈正相关。导管留置时间、穿刺次数、季节和免疫功能均与导管局部感染发生率显著相关(均P<0.05);随着穿刺次数的增加,导管局部感染的发生率显著增加,穿刺次数与导管局部感染的发生率呈正相关。结论PICC为白血病患者提供有效的长期血管通路。脆弱表型和缺陷累积脆弱指数与白血病患者行PICC导管治疗并发局部感染呈正相关。

Objective To study the value of fragile phenotype and defect cumulative vulnerability index in predicting the risk of local infection in patients with leukemia treated with PICC catheter.Methods From January 2016 to October 2019,117 leukemia patients who received chemotherapy and PICC intubation in our hospital were selected as the study objects.The vulnerability was assessed by the fragile phenotype and vulnerability index score of leukemia patients.The risk factors of local infection of catheter in leukemia patients were detected by multivariate logistic regression analysis.Purulent secretion samples were collected from the puncture site for bacterial culture to determine the distribution of pathogens.Results There were 19 cases of PICC catheter infection in 117 leukemia patients,with the incidence of infection of 16.24%.There was no statistically significant difference in the incidence of infection among ALL,CLL,AML,and CML patients(P>0.05).There were statistically significant differences in the fragile phenotype score,vulnerability index score,and catheter infection rate among different types of patients(all P<0.05).With the increase of fragile phenotype,the infection rate of PICC increased,and the fragile phenotype score was positively correlated with the infection rate of PICC.With the increase of the number of puncture,the incidence of catheter local infection increased significantly,and the number of puncture was positively correlated with the incidence of catheter local infection.Conclusion PICC provides long-term effective vascular access for leukemia patients.The fragile phenotype and the cumulative vulnerability index of defects are positively correlated with the local infection of PICC catheter in patients with leukemia.