不同锻炼方式预防老年肿瘤患者PICC相关性血栓的研究

Observation of different exercise modes on preventing peripherally inserted central catheter related venous thrombosis in elderly cancer patients

目的:探讨不同锻炼方式对老年肿瘤患者经外周静脉置入中心静脉导管(PICC)相关性血栓(PICCrelated VT)的预防效果。方法:将2017年10月至2019年11月在本院行PICC的153例老年肿瘤患者分为握拳锻炼组(50例)、握球锻炼组(52例)和手臂锻炼组(51例)。于置管前和置管后1、2、4周采用彩色多普勒超声检测腋静脉最大血流速度(Vmax)、单位时间平均血流速度(TMFV),并比较3组患者PICC-related VT发生情况。结果:置管后随着锻炼时间的延长,3组患者腋静脉Vmax和TMFV均呈逐渐上升趋势,3组间差异有统计学意义(P <0.05),其中手臂锻炼组腋静脉Vmax上升幅度大于握拳和握球锻炼组(P <0.05)。握拳锻炼组、握球锻炼组、手臂锻炼组置管4周内PICC-related VT发生率分别为28.0%、23.1%、7.8%,手臂锻炼组PICC-related VT发生率和血栓严重程度均低于另外两组,差异均有统计学意义(P <0.05);握拳和握球锻炼组各时间点血液流速及PICC-related VT发生率差异均无统计学意义(P> 0.05)。结论:手臂锻炼改善老年肿瘤患者PICC置管静脉血Vmax和预防PICC-related VT形成的效果优于握拳及握球锻炼,值得临床推广。

Objective: To explore the effect of different exercise modes on prevention of peripherally inserted central catheter related venous thrombus( PICC-related VT) in elderly cancer patients. Methods: 153 cases elderly cancer patients who received PICC catheterization in our hospital from October 2017 to November 2019 were divided into the handgrip exercise group( 50 cases),ball-holding exercise group( 52 cases),and arm exercise group( 51 cases). Before and after 1,2,4 weeks of PICC carrying,the maximum velocity( Vmax),time-mean flow velocity( TMFV) of axillary vein were measured by color Doppler ultrasound,and the incidence and severity of PICC-related VT were compared among the three groups. Results: With the extension of the exercise time after catheterization,the Vmaxand TMFV of axillary vein in the three groups showed a gradually increasing trend,and there were significant differences among the three groups( P < 0. 05). The degree of increased Vmaxin arm exercise group was more than that in handgrip exercise and ball-holding exercise group( P < 0. 05). Within 4 weeks after catheterization,the incidence of PICC-related VT was 28. 0%,23. 1% and 7. 8%,respectively,in handgrip exercise group,ball-holding exercise group and arm exercise group. The incidence and severity of PICC-related VT in arm exercise group was lower than that in the other two groups with statistical differences( P < 0. 05). There was no statistically significant difference in blood flow velocity and incidence of PICC-related VT between handgrip exercise and ball-holding exercise group( P > 0. 05). Conclusion: The effect of arm exercise on improving blood flow velocity of PICC catheter vein and preventing PICC-related VT in elderly cancer patients is better than that of handgrip exercise and ball-holding exercise,which is worthy of clinical promotion.