肿瘤患者PICC相关性导管外血栓的发生情况、溶栓效果和安全性的临床研究

Clinical Study on the Occurrence Efficacy and Safety of PICC-Related Extraductal Thrombosis in Tumor Patients

目的对肿瘤患者PICC相关性导管外血栓的发生情况、溶栓效果和安全性进行对比分析。方法选取广东省农垦中心医院2019年1月至12月收治的112例肿瘤患者作为研究对象,并随访至拔管。对比分析患者PICC相关性导管外血栓的发生情况、溶栓治疗效果和安全性。结果发生PICC相关性导管外血栓者15例,其中以PICC导管附壁血栓发生率最高。置管2个月内血栓发生率最高,达到7.22%,血栓者中PS评分1~2分者占比高于非血栓者,差异有统计学意义(P<0.05)。13例患者经华法林联合低分子肝素、利伐沙班治疗后血栓消失,其中采用华法林治疗出现轻度消化道出血者4例,而采用利伐沙班治疗出现1例PT明显延长。结论利伐沙班或华法林联合低分子肝素治疗PICC相关性血栓的临床效果均十分理想,但从患者治疗期间发生出血事件及服药剂量的调整频率来看,使用利伐沙班治疗PICC相关性血栓的安全性更高。

Objective To compare the occurrence,thrombolytic effect and safety of PICC-related extraductal thrombosis in tumor patients.Methods Totally 112 tumor patients admitted to Guangdong Agricultural Reclamation Center Hospital from January to December 2019 were selected as the research objects and followed up until extubation.Comparative analysis of the occurrence of PICC-related extracatheter thrombosis,thrombolytic therapy effect and safety.Results There were 15 cases of PICC related extraductal thrombosis,of which the incidence of PICC catheter-attached thrombus was the highest.The incidence of thrombosis was the highest within 2 months after catheterization,reaching 7.22%.The proportion of participants with PS scores 1-2 was higher among thrombosed than non thrombosed participants(P<0.05).The thrombus disappeared in 13 patients after warfarin combined with low molecular weight heparin and rivaroxaban.Among them,4 cases had mild gastrointestinal bleeding treated with warfarin,and 1 case with rivaroxaban showed significant prolongation of PT.Conclusion The clinical effects of rivaroxaban or warfarin combined with low molecular weight heparin in the treatment of PICC-related thrombosis are very satisfactory.However,from the perspective of bleeding events during the treatment period and the frequency of dosage adjustments,the use of rivaroxaban in the treatment of PICC-related thrombosis is more safe.