消化系统肿瘤患者的导管相关性血栓发生率及高危因素探讨

Incidence and risk factors of catheter-related thrombosis in patients with digestive system tumor

目的探讨消化系统肿瘤患者导管相关性血栓(CRT)的发生率以及高危因素,为制定合适的个体化防治策略提供依据。方法选择2015年1月1日至2019年8月31日在中国医学科学院肿瘤医院收治的计划接受中心静脉置管的消化系统恶性肿瘤患者529例。收集患者基线情况、静脉置管相关信息以及导管相关并发症的信息。所有患者带管期间至少接受一次血管超声检测。结果529例静脉置管患者总置管天数达33559 d。出现CRT共114例,发生率21.6%,即3.40例/1000置管日。CRT最常见于锁骨下静脉,共53例,占比46.5%。多因素回归分析结果显示:食管癌(对比胃癌:OR=2.087,95%CI:1.146~3.088,P=0.016)、使用PICC置管(OR=2.379,95%CI:1.422~3.980,P=0.001)以及化疗(OR=2.258,95%CI:1.165~4.375,P=0.016)为CRT发生的独立危险因素。结论食管癌、PICC置管及化疗是CRT的独立危险因素。

Objective To explore the incidence and risk factors of catheter-related thrombosis(CRT)in patients with digestive system tumors,and to provide the basis for formulating appropriate prevention and treatment strategies.Methods From January 1,2015 to August 31,2019,529 patients with malignant digestive system tumor admitted to National Cancer Center/Cancer Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College and planned to receive central venous catheterization were included.Baseline information,catheter-related information,and catheter-related complications were collected.All patients received vascular ultrasound examination at least once before extubation.Results The total number of catheter days was 33559.The incidence of CRT was 21.6%,which was 3.40 cases/1000 day.CRT was most common in subclavian vein in 53 cases(46.5%).Multivariate regression analysis showed that esophageal cancer(compared to gastric cancer:OR=2.087,95%CI:1.146-3.088,P=0.016),PICC catheter(OR=2.379,95%CI:1.422-3.980,P=0.001)and chemotherapy(OR=2.258,95%CI:1.165-4.375,P=0.016)were independent risk factors for CRT.Conclusion The independent risk factors of CRT include esophageal cancer,PICC catheter and chemotherapy.