长期卧床PICC置管患者上肢静脉血栓形成危险因素分析

Risk factors analysis of upper limb venous thrombosis in long-term bedridden patients with PICC catheterization

目的探讨长期卧床PICC置管患者上肢静脉血栓形成的危险因素。方法2019年1月至2020年10月在我院行PICC的患者达1100例,选择其中80例的临床资料进行回顾性分析,根据是否发生上肢静脉血栓分为血栓组22例与非血栓组58例。记录患者一般资料及临床资料,分析影响患者上肢静脉血栓形成危险因素。结果(1)糖尿病、NRS 2002≥3分、APACHEⅡ评分≥8分、有PICC置管史、有化疗史、有导管堵塞、有导管相关感染、置管后导管移位、TG升高、TC升高、D-二聚体升高的患者血栓发生率更高,口服抗凝剂的患者血栓发生率更低,差异有统计学意义(P<0.05)。(2)糖尿病、NRS 2002≥3分、APACHEⅡ评分≥8分、有PICC置管史、有化疗史、有导管堵塞、有导管相关感染、置管后导管移位、TG升高、TC升高、D-二聚体升高是长期卧床PICC置管患者上肢静脉血栓形成的独立危险因素,而口服抗凝剂是保护因素(P<0.05)。结论长期卧床PICC置管患者,应注意预防血栓形成。在PICC置管过程中应严格执行操作规范,以降低相关血栓形成的风险。

Objective To explore the risk factors of upper limb venous thrombosis in long-term bedridden patients with PICC catheterization.Methods A total of 1100 patients were performed PICC in our hospital from January 2019 to October 2020.Clinical data of 80 of them were selected for retrospective analysis and divided into thrombotic group(n=22)and non-thrombotic group(n=58)according to the occurrence of upper limb venous thrombosis.The general information and clinical data of the patients were recorded,and the risk factors of upper limb venous thrombosis were analyzed.Results①There was a higher incidence of thrombosis in patients with the following factors:Diabetes,NRS 2002≥3 points,APACHE Ⅱ≥8 points,history of PICC catheter,history of chemotherapy,catheter blockage,catheter associated infection,catheter displacement after catheterization,increased TG,TC and D-dimer.There was a lower incidence of thrombosis in patients who took anticoagulants orally.The differences were statistically significant(P<0.05).②Diabetes,NRS 2002≥3 points,APACHE Ⅱ≥8 points,history of PICC catheter,history of chemotherapy,catheter blockage,catheter associated infection,catheter displacement after catheterization,increased TG,TC and D-dimer were independent risk factors for upper limb venous thrombosis in long-term bedridden patients with PICC catheterization,while orally taking anticoagulants was a protective factor(P<0.05).Conclusion Long-term bedridden patients with PICC catheterization should pay attention to prevent thrombosis.Operation specifications should be strictly followed during PICC catheterization to reduce the risk of related thrombosis.