肿瘤患者PICC相关上肢深静脉血栓形成的治疗

Treatment of PICC associated upper extremity deep venous thrombosis in tumor patients

目的探讨肿瘤患者PICC导管相关急性上肢深静脉血栓形成(UEDVT)的治疗方法。方法回顾性分析天津市第一中心医院2014年7月1日-2017年6月30日收治的258例恶性肿瘤合并PICC导管相关急性UEDVT患者的临床资料,所有患者均给予抗凝治疗,至少抗凝3个月,抗凝时间>3个月患者利伐沙班减量为10mg/d。结果随访时间5~36个月,中位随访时间13个月。抗凝期间出现1例肺栓塞,无上肢静脉复发或出现下肢深静脉血栓形成,出血事件发生率为4.3%(11/255),抗凝停药后出现静脉血栓栓塞症占2.0%(5/255),血栓后遗症的发生率为6.7%(17/255)。结论抗凝是恶性肿瘤合并PICC导管相关急性UEDVT的主要治疗措施,新型口服抗凝药物治疗UEDVT的疗效确切,安全性良好,值得临床推广应用。

Objective To explore the treatment of PICC catheter-related acute upper extremity deep venous thrombosis(UEDVT) in tumor Patients. Methods The clinical data of 258 patients with malignant tumor complicated with PICC catheter-associated acute UEDVT admitted to Tianjin First Central Hospital from July 1,2014 to June 30,2017 were analyzed retrospectively. All patients were given anticoagulant treatment. All patients were anticoagulant for at least 3 months. The reduction of rivaroxaban was 10 mg/d for patients with anticoagulation time >3 months. Results Follow-up time was 5-36 months,and the median follow-up time was 13 months. During anticoagulation,there was 1 case of pulmonary embolism,there was no recurrence of upper extremity venous or deep venous thrombosis of lower extremity. The incidence of bleeding events was 4.3%(11/255). After anticoagulation drug withdrawal,there was 2.0%(5/255) of venous thromboembolism and 6.7%(17/255) of post-thrombotic syndrome.Conclusion Anticoagulation was the main treatment measure of malignant tumor associated with PICC catheter-related acute UEDVT. The new oral anticoagulant drugs were effective and safe in the treatment of UEDVT,which was worthy of clinical promotion and application.